Mohamed Wesam, Elsawaf Mohamed I, Shalaby Aly I, Arafat Ahmed E, Marei Mahmoud M, Aboulfadl Mohamed H, Kaddah Sherif N, El Tagy Gamal H, Bahaaeldin Khaled H K
Department of Pediatric Surgery, Cairo University Specialized Pediatric Hospital, Cairo, Egypt.
Department of Pediatric Surgery, Tanta University, Tanta, Egypt.
J Indian Assoc Pediatr Surg. 2021 Jan-Feb;26(1):16-22. doi: 10.4103/jiaps.JIAPS_187_19. Epub 2021 Jan 11.
Hirschsprung's disease (HD) has been traditionally treated from infancy onward and different techniques have been used including Swenson, Soave, and Duhamel procedures. The purpose of this study was to evaluate the transanal Swenson's procedure for classical rectosigmoid HD in neonates.
This was a prospective study in which neonates diagnosed with HD were recruited from January 2017 to December 2018. Cases with a transition zone proximal to the midsigmoid were excluded. All patients underwent a transanal Swenson's procedure in the neonatal period using a unified protocol. Intraoperative course and postoperative outcomes such as leak, pelvic abscess, soiling, perianal excoriation, stricture, enterocolitis, and constipation were evaluated and all patients were followed for at least 6 months.
Twenty-three patients (17 males and 6 females) underwent transanal Swenson's procedure. The mean age was 22 ± 5.7 days. Follow-up ranged from 6 to 30 months. No anastomotic leak, retraction, or prolapse was reported. Mild perianal excoriations occurred early in 9 (39%) cases and all responded to medical treatment and disappeared before 2 months postoperatively. Stricture occurred in 2 (8%) patients, enterocolitis in 3 (13%), and constipation in 3 (13%).
Transanal Swenson's procedure is feasible and can be performed safely in neonates with rectosigmoid HD with good short-term outcomes. Proper patient selection and standard protocol following fine procedural hall-marks and details are keys for optimal results and patient satisfaction.
先天性巨结肠（HD）传统上从婴儿期就开始治疗，并且使用了不同的技术，包括斯文森手术、索阿韦手术和杜哈梅尔手术。本研究的目的是评估经肛门斯文森手术治疗新生儿经典型直肠乙状结肠HD的效果。
这是一项前瞻性研究，2017年1月至2018年12月招募了被诊断为HD的新生儿。乙状结肠中部近端有移行区的病例被排除。所有患者在新生儿期采用统一方案接受经肛门斯文森手术。评估术中过程和术后结果，如渗漏、盆腔脓肿、便污、肛周皮肤擦伤、狭窄、小肠结肠炎和便秘，所有患者至少随访6个月。
23例患者（17例男性和6例女性）接受了经肛门斯文森手术。平均年龄为22±5.7天。随访时间为6至30个月。未报告吻合口漏、回缩或脱垂。9例（39%）患者早期出现轻度肛周皮肤擦伤，所有患者经药物治疗后均有反应，并在术后2个月前消失。2例（8%）患者出现狭窄，3例（13%）出现小肠结肠炎，3例（13%）出现便秘。
经肛门斯文森手术是可行的，对于直肠乙状结肠HD的新生儿可以安全进行，短期效果良好。正确的患者选择以及遵循精细手术标志和细节的标准方案是获得最佳结果和患者满意度的关键。
