Efficacy of laparoscopic-assisted transanal modified Soave procedure in the treatment of Hirschsprung’s disease

Abstract

Objective To investigate the clinical value of laparoscopic-assisted transanal modified Soave procedure in the treatment of Hirschsprung’s disease (HD). Methods Thirty children with HD who were admitted to Children’s Hospital of Shanxi from January 2013 to November 2016 were treated by laparoscopic-assisted transanal modified Soave. The operation time, intraoperative bleeding volume and complications were analyzed retrospectively. The results of anal resting pressure, anal systolic pressure and intraanal ultrasonography before and after operation were compared. Results All patients underwent laparoscopic-assisted operation. The average length of the intestine was (9.43±3.34) cm, the average operation time was (121.43±21.45) min, and the mean blood loss during operation was (6.86±0.23) ml, while the average length of hospital stay was (11.8 ± 4.2) d. Two children had enterocolitis 6 and 8 days after surgery, but had no colon stenosis or obstruction according to examination; and they were cured after conservative treatment. Two cases had pediatric pneumonia after operation, and been recovered by inner medical treatment. One child developed filth and was improved after defecation training. All the surgical incisions healed in grade A, and no one had abdominal bleeding or anastomotic leakage after operation. Two children were admitted to hospital on the 50th day after operation due to enterocolitis, and they were cured after enema and other conservative treatments. In 6 months after operation, the frequency of bowel movements was 5 to 10 times/d in 3 cases, 1 to 5 times/d in 25 cases. Two cases had constipation, compilcated by anastomotic stenosis; but they were improved after anal training again. Anal internal sphincter thickness and anal canal resting pressure decreased after operation, according to anal ultrasound and anorectal pressure test; however, the difference was not statistically significant (P>0.05). All children with normal stool were followed up for 1 year, and the frequency of bowel movements was 2 to 5 times/d, but no megacolon symptoms, anal stenosis and anal incontinence or other circumstances occurred. Conclusions Laparoscopic-assisted Soave radical surgery for the treatment of children with HD is safe and effective, with fewer complications. The children recover quickly without internal sphincter injury. so this treatment method has good short-term and long-term clinical effects. Key words: Laparoscopy; Modified Soave; Hirschsprung’s disease; Anal straight line