Chen Feng, Wei Xiaoyu, Chen Xiaohua, Xiang Lei, Feng Jiexiong
Department of Pediatric Surgery, Fujian Medical University Union Hospital, Fuzhou, China.
Department of Pediatric Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Front Pediatr. 2021 Apr 27;9:600316. doi: 10.3389/fped.2021.600316. eCollection 2021.
The aim of this study was to describe the details of laparoscopic-assisted reoperative surgery for Hirschsprung's disease (HSCR) with overflow fecal incontinence, and to retrospectively compare laparoscopic-assisted surgery with transabdominal pull-through surgery. We retrospectively analyzed patients with HSCR with overflow fecal incontinence after the initial surgery in our center between January 2002 and December 2018. Pre-operative, peri-operative, and post-operative data were recorded for statistical analysis. Thirty patients with overflow fecal incontinence after initial megacolon surgery [17 who underwent transanal pull-through (TA-PT) and 13 who underwent laparoscopic-assisted pull-through (LA-PT)] required a secondary surgery [reoperation with LA-PT (LAR-PT) ( = 16) or reoperation with transabdominal pull-through (TR-PT) ( = 14)]. Indications for reoperation were residual aganglionosis (RA) (7/30, 23.3%) or transition zone pathology (TZP) (23/17, 76.7%). Blood loss was significantly decreased in the LAR-PT group (75 ± 29.2 ml) compared to the TR-PT group (190 ± 51.4 ml) ( = 0.001). The length of hospital stay was significantly shorter in the LAR-PT group (10 ± 1.5 days) than that in the TR-PT group (13 ± 2.4 days). No significant differences were found between two groups in surgical methods, defecation function score, or post-operative complications except for wound infection (LAR-PT vs. TR-PT 0 vs. 28.6%, < 0.05). It is necessary to make a comprehensive analysis of the causes of fecal incontinence after HSCR surgery and make an accurate judgment using appropriate methods. If a reoperation was inevitable for patients with overflow fecal incontinence due to RA or TZP, a comprehensive evaluation prior to the operation is required to maximize the benefit from reoperation. Although laparoscopic reoperation with heart-shaped anastomosis was safe and feasible for patients with failed initial Soave technique, unnecessary reoperation should be avoided as much as possible.
本研究的目的是描述针对患有充溢性大便失禁的先天性巨结肠症（HSCR）患者进行腹腔镜辅助再次手术的细节，并回顾性比较腹腔镜辅助手术与经腹拖出式手术。我们回顾性分析了2002年1月至2018年12月期间在本中心初次手术后患有充溢性大便失禁的HSCR患者。记录术前、术中及术后数据用于统计分析。30例初次巨结肠手术后出现充溢性大便失禁的患者[17例行经肛门拖出术（TA-PT），13例行腹腔镜辅助拖出术（LA-PT）]需要二次手术[再次行LA-PT手术（LAR-PT）（n = 16）或再次行经腹拖出术（TR-PT）（n = 14）]。再次手术的指征为残留无神经节细胞症（RA）（7/30，23.3%）或移行区病变（TZP）（23/30，76.7%）。与TR-PT组（190±51.4 ml）相比，LAR-PT组的失血量显著减少（75±29.2 ml）（P = 0.001）。LAR-PT组的住院时间（10±1.5天）明显短于TR-PT组（13±2.4天）。除伤口感染外，两组在手术方式、排便功能评分或术后并发症方面未发现显著差异（LAR-PT组与TR-PT组分别为0与28. �6%，P < 0.05）。有必要对HSCR手术后大便失禁的原因进行综合分析，并采用适当方法做出准确判断。对于因RA或TZP导致充溢性大便失禁且不可避免需要再次手术的患者，术前需要进行全面评估，以最大程度地从再次手术中获益。尽管对于初次Soave术失败的患者，采用心形吻合的腹腔镜再次手术是安全可行的，但应尽可能避免不必要的再次手术。
