The choice of operative procedures for Hirschsprung's disease allied diseases in children

Abstract

Objective To determine operative procedures for Hirschsprung's disease allied diseases (HAD) in children. Methods From Jun. 2008 to Dec. 2010, 45 consecutive patients with an average ages of 35.5 ± 5 months underwent radical surgery for HAD in one surgical group, including 33 hypoganglionosis (HG) and 12 intestinal neuronal dysplasia (IND). All patients have been followed up at 1, 3, 6 and 12 months after surgery. Defecation function were studied and compared with that before surgery, Results Among the 33 HG patients, 17 patients (52％) underwent open surgery, the other 16 (48％) underwent transanal or laparoscopic-assisted pull-through surgery including left colectomy on 28 (84.8％) and subtotal colectomy on 5 (15.2％). All IND patients underwent oPen surgery, and left colectomy were performed on 4(33.3％) and subtotal colectomy on 8 (66.7％). Constipation disappeared in all patients during follow-up after surgery. No death and severe complication was noted. The incidence of soiling was significantly higher in patients with transanal pull-through procedure than that patients underwent open surgery 1 year after surgery (P＜0.05). Anorectal manometry for the patients with soiling showed the parameter of manometry was decreased markedly at the 3rd month after surgery is compared with preoperative manometry(52.17 ± 0.31 )mmHg vs. (66.5 ± 11.67)mmHg. However, manometry at 6th or 12th postoperative month is(58 ± 5.7)mmHg was not different with preoperative manometry. Conclusions The choice of operative procedures for HAD should be based on different pathological types and clinical conditions. Primary HG lesions can be removed directly by a simple transanal pull-through or laparoscopic-assisted surgery. For HG patients with previous anorectal surgery or in older children, the surgical procedures of saving the anorectal sphincter morphology and function should be chosen. For IND children, radical subtotal colectomy and low level anastomosis within pelvic should be performed. It was not advocated using a simple transanal pull-through procedure for IND children. The rate of soiling in transanal pull-through group was higher than that in open surgery group 1 year after surgery. Neither left nor subtotal colectomy was associated with the incidence of postoperative soiling. Key words: Hirschsprung's disease; Colorectal surgery