Modified Duhamel Retrorectal Pull-Through for Hirschsprung’s Disease

2021 ◽  
Vol 15 (10) ◽  
pp. 2886-2889
Author(s):  
Shafiq ur Rehman ◽  
Muhammad Anwar ◽  
Zarlish Fazal
Keyword(s):  
Hirschsprung's Disease ◽  
Hirschsprung’S Disease ◽  
Operation Time ◽  
Clinical Score ◽  
Toilet Training ◽  
Paediatric Surgery ◽  
Short Term ◽  
Female Ratio ◽  
Bowel Habits ◽  
Pull Through

Objectives: To evaluate the post-operative complications and short-term outcomes of modified Duhamel retrorectal pull-through procedure for Hirschsprung’s disease. Design: Prospective descriptive study Place and Duration of Study: Department of Paediatric Surgery Sahiwal Teaching Hospital Sahiwal from 1stJanuary 2018 to 31st December 2020. Methodology: Thirty seven histologically confirmed cases of Hirschsprung’sdisease having previous decompressing colostomy/stoma age between 1 to 12 years of agewere included. Children under one year of age, with sever comorbidities like Down syndrome and cardiac abnormalities, and those who require re-do pull through procedure were excluded. Modified Duhamel retrorectal pull-through procedure was performed in all cases. The demographic information included age, sex, proximal level of aganglinosis, complications of definite procedure, length of hospitalization andmortality. Other information recorded included long term complications like obstructive symptoms, enterocolitis, incontinence and soiling at follow up. Krickenbeck classification was used to evaluate faecal incontinence and constipation. Kelly’s clinical score was used to assess the anal sphincter. Bowel habits were assessed only in children above three years of age. Results: Twenty six (70.27%) were males and 11 (29.72%) females with male to female ratio 2.3:1 and mean age at operation was 2.89±1-9 years. Twenty nine (78.37%) children were ≤3 years of age and 8 (21.62%) were >3 years. Mean weight was 12.91 kgs, operation time was 126.81 time, fasting time was 6.67 days and hospital stay was 11.91 days. Length of aganglionic segment was short segment 27 (72.97%), long segment 9 (24.32%) and total colonic 1 (2.7%). Hirschsprung associated enterocolitis 7 (18.91%) and wound infection 6(16.21%) were most common reported complications. Constipation in 5(13.51) and soiling with retentive constipation was present in 3 (8.10%) patients. Out of total 31 patients who reached toilet training age, 28 (90.32%) developed satisfactory voluntary bowel habits. Conclusion: Modified Duhamel pull-through procedure was found to be safe, applicable and with lower associated complications and satisfactory short term functional outcomes in our settings. Key words: Hirschsprung’s disease, Modified Duhamel pull-through procedure, Complications, Outcomes

scholarly journals Classic Swenson abdomino perineal pull through in the treatment of Hirschsprung’s Disease – 3 years experience in a tertiary care Paediatric Hospital in Bangladesh

2017 ◽  
Vol 8 (1) ◽  
pp. 185-188
Author(s):  
Khalid Mahmud ◽  
AR Khan ◽  
BH Nazma Yasmeen ◽  
MK Islam ◽  
Sabbir Karim
Keyword(s):  
Urinary Incontinence ◽  
Fecal Incontinence ◽  
Tertiary Care ◽  
Operation Time ◽  
Definitive Treatment ◽  
Paediatric Surgery ◽  
Short Term ◽  
Total Colonic Aganglionosis ◽  
Female Ratio ◽  
Pull Through

Background : Hirschsprung disease (HD)is a common cause of intestinal obstruction. Definitive treatment is to excise aganglionic segment and anastomosis with anal remnant.Objective : The aim of the study was to analyze the short term outcome of children who have undergone the Classic swenson abdominoperineal pull through operation in the treatment of Hirschsprung’s disease.Methods : This Prospective study had been carried out in the department of paediatric surgery, Dhaka shishu (Children) Hospital during the period of January 2013 to January 2016. Total 50 patients with Hirschsprung’s disease with or without colostomy except total colonic aganglionosis were included in this study.We also excluded those patients with major co-morbidities and patients who did not agree to close stoma within 12 weeks of pull through. Consideration was given to postoperative complications(Cuff /anastomotic/pelvic abscess, wound infection, anastomotic leakage,fecal incontinence, urinary incontinence, mortatality), operation time and post operative hospital stay and as well as the short term outcome.Result : Among the study population 36 (72%) were male and 10(28 %) were female with a male female ratio of 2.5:1. Mean age at presentation was 17.96±12.05 months.Thirty eightpatients had diverting colostomy and underwent staged procedure.On the other hand 12 patients had no colostomy and underwent single stage procedure.Four patientsdeveloped anastomoticabcess, 3patients developed urinary incontinence,4 fecal incontinence and 2 patients developed post operative intestinal obstruction.The mean Operation time was114.14±13.02 minutes and mean hospital staywas 6.18±1.83 days.Thirty seven patients were discharged without any complications.Conclusion : The Classic Swenson’s procedure is an effective procedure in the treatment of HD .Northern International Medical College Journal Vol.8(1) July 2016: 185-188

Total Colonic Hirschsprung's Disease: The Hypermotility and Skin Rash Protocol

2019 ◽  
Vol 30 (04) ◽  
pp. 309-316 ◽  
Author(s):  
Alejandra Vilanova-Sanchez ◽  
Monica Ivanov ◽  
Devin R. Halleran ◽  
Andrea Wagner ◽  
Carlos Albert Reck-Burneo ◽  
...  
Keyword(s):  
Hirschsprung's Disease ◽  
Hirschsprung’S Disease ◽  
Failure To Thrive ◽  
Toilet Training ◽  
Bowel Management ◽  
High Incidence ◽  
Before And After ◽  
Perineal Skin ◽  
Bowel Movements ◽  
Pull Through

Introduction Total colonic Hirschsprung's disease (TCHD) presents a postoperative challenge due to multiple stools and perineal rash. We propose a protocol developed by pediatric surgeons and ostomy nurses to help prevent and treat hypermotility and severe perineal rash, especially in younger children who are not toilet trained. Materials and Methods We retrospectively reviewed our TCHD patients' charts from 2014 to 2017. All patients received a prescribed protocol for the treatment of hypermotility and perineal rash. We describe patients who underwent their pull through before and after the age of urine toilet training, and assessed the number of bowel movements, the perineal skin status, and growth. Results We treated 25 patients. Out of 25, 9 patients received a straight ileoanal pull through before the age of 18 months. Nine of 25 patients presented for a second opinion and had redo pull through. The remaining seven presented for bowel management after having a pull through at another institution. All these were treated following the hypermotility protocol. In total, 19 of 25 patients were not toilet trained. The mean number of bowel movements in all groups was 4 (3–5). All had a resolution of perineal rash and liquid stools after 3 months. Eleven of the 25 patients presented with failure to thrive. Two older patients experienced severe proctalgia requiring replacement of the ileostomy. Conclusion TCHD patients who underwent definitive pull through had nine high incidence of multiple stool, perineal rash, and low growth. With the implementation of bowel management care to slow the stools and a perineal skin protocol to treat the skin, we believe that these symptoms can be minimized even in patients who are not toilet trained. Since the implementation of this protocol, we have changed our practice to perform the pull through in such patients between the age of 6 and 18 months.

scholarly journals Etiology and Treatment Outcome of Neona tal Intestinal Obstruction in a Tertiary Hospital

2009 ◽  
Vol 22 (2) ◽  
pp. 198-203
Author(s):  
SS Islam ◽  
MA Nowshad ◽  
A Jator ◽  
I Faisal ◽  
M Ahmed
Keyword(s):  
Intestinal Obstruction ◽  
Hirschsprung's Disease ◽  
Hirschsprung’S Disease ◽  
Intestinal Atresia ◽  
Paediatric Surgery ◽  
College Hospital ◽  
Female Ratio ◽  
Neonatal Intestinal Obstruction ◽  
Surgery Department

A prospective study was conducted on 54 cases of neonatal intestinal obstruction, admitted in Paediatric surgery department of Rajshahi Medical College Hospital during the period from January 2008 to December 2008, a period of 12 months. The objective of the study was to find out etiological aspect and outcome of admitted patient with neonatal intestinal obstruction. The patient constituted 33.7% of total neonatal admission in Paediatric surgery department during the study period. The male: female ratio was 1.4:1 with age ranging from 1 to 28 days. Birth weight of most of the patients was above 2 kg. Most of the patients came from poor and average family. Patients from poor family are slightly ahead. Plain x-ray abdomen was done in all cases in our study. Contrast radiography performed in selected cases. Ultrasound scan done to in selective case to rule out IHPS. No rectal biopsy was taken in case of suspected Hirschsprung's disease. The causes of neonatal intestinal obstruction were in order of frequency-Hirschsprung's disease (45.2%), Intestinal atresia (24.5%), malrotation (9.4%), bands & adhesion (5.6%), meconium ileus (5.6%), volvulus neonatarum (5.6%), meconium plug syndrome (1.8%), unknown (3.7%). 50 patients were treated operatively. 28.3% cases developed complications. Most of the complications were related to colostomy and sepsis. Overall mortality was 20.8%. Mortality was maximum in intestinal atresia. Every patient was advised to come for follow up at the time of discharge but most of the people did not report. In the study only 17 (32.1%) patient came for follow up as per advice.TAJ 2009; 22(1): 198-203

scholarly journals The follow-up of the robotic-assisted Soave procedure for Hirschsprung’s disease in children

2021 ◽  
Author(s):  
Tran Anh Quynh ◽  
Pham Duy Hien ◽  
Le Quang Du ◽  
Le Hoang Long ◽  
Nguyen Thi Ngoc Tran ◽  
...  
Keyword(s):  
Hirschsprung's Disease ◽  
Hirschsprung’S Disease ◽  
Pediatric Patients ◽  
Three Dimensional ◽  
Dentate Line ◽  
Robotic Arms ◽  
Robotic Assisted ◽  
The Mean ◽  
Pull Through

AbstractRobotic surgery offers three-dimensional visualization and precision of movement that could be of great value to gastrointestinal surgeons. There were many previous reports on robotic technology in performing Soave colonic resection and pull-through for Hirschsprung’s disease in children. This study described the follow-up of the Robotic-assisted Soave procedure for Hirschsprung’s disease in children. Robotic-assisted endorectal pull-through was performed using three robotic arms and an additional 5-mm trocar. The ganglionic and aganglionic segments were initially identified by seromuscular biopsies. The rest of the procedure was carried out according to the Soave procedure. We left a short rectal seromuscular sleeve of 1.5–2 cm above the dentate line. From December 2014 to December 2017, 55 pediatric patients were operated on. Age ranged from 6 months to 10 years old (median = 24.5 months). The aganglionic segment was located in the rectum (n = 38), the sigmoid colon (n = 13), and the left colon (n = 4). The mean total operative time was 93.2 ± 35 min (ranging from 80 to 180 min). Minimal blood was lost during the surgery. During the follow-up period, 41 patients (74.6%) had 1–2 defecations per day, 12 patients (21.8%) had 3–4 defecations per day, and 2 patients (3.6%) had more than 4 defecations per day. Fecal incontinence, enterocolitis, and mild soiling occurred in three (5.4%), four (7.3%), and two pediatric patients, respectively. Robotic-assisted Soave procedure for Hirschsprung’s disease in children is a safe and effective technique. However, a skilled robotic surgical team and procedural modifications are needed.

Long-Term Outcomes and Quality of Life in Patients after Soave Pull-Through Operation for Hirschsprung's Disease: An Observational Retrospective Study

2017 ◽  
Vol 28 (05) ◽  
pp. 445-454 ◽  
Author(s):  
Tania Mahler ◽  
Martine Dassonville ◽  
Dinh Truong ◽  
Annie Robert ◽  
Philippe Goyens ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Fecal Incontinence ◽  
Hirschsprung's Disease ◽  
Hirschsprung’S Disease ◽  
Bowel Function ◽  
Long Term Outcomes ◽  
Neurologic Impairment ◽  
Pull Through

Introduction Patients after pull-through operation for Hirschsprung's disease (HD) are at high risk of defecation disorders. This study aimed at investigating their long-term outcomes and quality of life (QoL) in comparison with controls. Patients and Methods Patients older than 5 years operated on for HD were interviewed to complete detailed questionnaires on bowel function. Patients without neurologic impairment were enrolled in a QoL survey to compare with controls matched for sex and age and selected randomly from the general population using sampling set in a ratio of four controls to one case of HD. Results In total, 53 operated patients were enrolled. Mean age of the patients was 16 ± 8 years, with 68% boys. Rectosigmoid aganglionosis was the most seen form of HD in 38 (72%) cases. Open Soave was performed in 40 (75.5%) cases, and minimally invasive surgery Soave (MIS Soave) in 13 (24.5%) cases. At investigation, prevalence of fecal incontinence and constipation were 22.6 and 13.2%, respectively. Regarding QoL survey, 45 patients and 180 controls were enrolled, excluding 8 patients with neurologic impairment. Thirty-seven (82.2%) patients were classified as having a good QoL (score ≥ 9 points); whereas six had a fair QoL (5–8 points) and two had a poor QoL (< 5 points). QoL score in the cases and the controls were 10.2 ± 2.5 and 11.9 ± 0.4 points, respectively. Long aganglionosis form of HD was significantly associated with a low QoL (score < 8 points), adjusted odds ratio = 9, 95% confidence interval [1.3; 64.1] (p < 0.05). In subscales analyses, the prevalence of each dimension including fecal continence, school absenteeism, unhappiness or anxiety, food restriction, and peer rejection was significantly higher in operated patients than in controls (p <0.001). Conclusion Although the QoL of patients operated on for HD in general was with good outcomes, fecal incontinence and constipation still are problematic issues and challenges in a high percentage of patients. Therefore, a long-term and multidisciplinary follow-up is essentially required for these patients.

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