Unit of Pediatric Surgery, Addis Ababa University, Addis Ababa, Ethiopia.
Department of Pathology, Addis Ababa University, Addis Ababa, Ethiopia.
BMC Surg. 2022 Mar 8;22(1):89. doi: 10.1186/s12893-022-01536-9.
Over the past few decades, surgery for Hirschsprung's disease (HD) has evolved into a minimally invasive, single-stage procedure with excellent outcomes. Intraoperative frozen section biopsy is critical for this procedure to avoid the potential risk of leaving a retained aganglionic segment. However, this facility is not available in most low-income countries. Therefore, a two-stage procedure with an initial colostomy is still practiced in the developing world. We aimed to evaluate the outcome of single-stage transanal pullthrough performed in a facility without frozen section biopsy.
A retrospective review of all patients who underwent transanal pullthrough in two teaching hospitals over a 6-year period (2015-2020).
Forty-seven children underwent transanal endorectal pullthrough (TERPT). Age at surgery ranged from 2 months to 6 years and mean weight was 8.7 kg. Barium enema did not show transition zone in 6 patients (12.8%) while others demonstrated short segment HD. Intraoperatively, the transition zone was visualized in 40 patients (85%). TERPT alone was performed in 35 (74.5%), TERPT with laparotomy to visualize transition zone in 9 (26.7%) and TERPT with transabdominal mobilization was required in 3 (6.4%). Definitive histopathologic examination revealed aganglionic segment pullthrough in 4 (8.5%) and transitional zone pullthrough in another 4 (8.5%). However, with long term follow up all eight children remained asymptomatic and no intervention was required.
Transanal pullthrough offers reduced number of surgeries and faster recovery. We have also observed a good functional outcome despite a discrepancy with pathology results. Overall, our data suggests it is a safe and viable option for the treatment of short segment HD in facilities where frozen section is not available.
在过去的几十年中，先天性巨结肠症（HD）的手术已经演变为微创、单阶段手术，具有良好的疗效。术中冷冻切片活检对于避免遗留未分化肠段的潜在风险至关重要。然而，大多数低收入国家都没有这种设备。因此，在发展中国家仍然采用初始结肠造口术的两阶段手术。我们旨在评估在没有冷冻切片活检设备的机构中进行单阶段经肛门拖出术的结果。
回顾性分析了在两所教学医院进行经肛门拖出术的所有患者的资料，时间跨度为 6 年（2015-2020 年）。
47 例儿童接受经肛门直肠内拖出术（TERPT）。手术时的年龄为 2 个月至 6 岁，平均体重为 8.7kg。6 例（12.8%）钡灌肠未见过渡区，其余均为短段 HD。术中，40 例（85%）患者可见过渡区。35 例（74.5%）仅行 TERPT，9 例（26.7%）需剖腹探查以观察过渡区，3 例（6.4%）需经腹游离。最终病理检查显示 4 例（8.5%）存在无神经节细胞段拖出，另有 4 例（8.5%）存在过渡区拖出。然而，长期随访发现所有 8 例患儿均无症状，无需干预。
经肛门拖出术可减少手术次数，加快康复速度。尽管与病理结果存在差异，但我们也观察到了良好的功能结果。总体而言，我们的数据表明，在没有冷冻切片的情况下，对于短段 HD，经肛门拖出术是一种安全可行的治疗选择。
