Zheng Zebing, Jin Zhu, Gao Mingjuan, Tang Chengyan, Huang Lu, Gong Yuan, Liu Yuanmei
Department of Pediatric, General Thoracic and Urinary Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, China.
Front Pediatr. 2022 Apr 5;10:578843. doi: 10.3389/fped.2022.578843. eCollection 2022.
Our institution had modified the Soave pull-through procedure using laparoscopic stepwise gradient muscular cuff cutting (LSGC) for Hirschsprung disease (HSCR). However, we found that a few children still suffered from obstructive symptoms and enterocolitis during the follow-up. Previous studies suggested that these symptoms might be caused by the retained muscular cuff. The purpose of this study was to employ a modified procedure of laparoscopic complete excision of the posterior muscular cuff (LCEPC) for HSCR and compare it with the laparoscopic stepwise gradient cutting muscular cuff (LSGC) procedure.
Our institution records of 83 patients with classic form HSCR who underwent LSGC or LCEPC between August 2014 and July 2018 at the Pediatric Surgery Department of Zunyi Medical University (Zunyi, China) were carefully reviewed (LSGC, = 52; LCEPC, = 31). In the present study, we compared the postoperative complications and defecation functions of the two groups. All patients were followed-up (1-5 years, with an average of 2 years).
There were no differences regarding the operation time and the length of hospitalization between groups, while the anal dissection time in the LCEPC group (22.4 ± 4.8 min) was shorter than that of the LSGC group (45.5 ± 7.5 min) ( < 0.001). The postoperative complication of soiling was significantly increased in six patients (19.4%) in the LCEPC group compared with two patients (3.8%) in the LSGC group ( = 0.021). However, the total incidence of enterocolitis (two patients, 6.5%) was significantly decreased in the LCEPC group compared with the LSGC group (12 patients, 23.1 %) ( = 0.050). For anastomotic stricture, muscular cuff infection, and constipation, there were no significant differences between the two groups. No patients experienced bladder paralysis and incontinence postoperatively in this study. Anorectal manometries presented that the anorectal resting pressure was significantly lower in the LCEPC group (14.8 ± 2.7 mmHg) than the LSGC group (22.0 ± 3.8 mmHg), ( < 0.001).
The laparoscopic complete excision of the posterior muscular cuff method was demonstrated as safe and efficient, with a decrease in the incidence of enterocolitis, although it may increase the number of soiling incidents in the short period post-surgery owing to a dissected partial internal anal sphincter.
我们的机构对Soave拖出术进行了改良，采用腹腔镜逐步梯度肌袖切断术（LSGC）治疗先天性巨结肠（HSCR）。然而，我们发现仍有少数儿童在随访期间出现梗阻症状和小肠结肠炎。既往研究表明，这些症状可能是由残留的肌袖引起的。本研究的目的是采用改良的腹腔镜后肌袖完全切除术（LCEPC）治疗HSCR，并与腹腔镜逐步梯度切断肌袖（LSGC）手术进行比较。
仔细回顾了2014年8月至2018年7月在遵义医科大学（中国遵义）小儿外科接受LSGC或LCEPC手术的83例典型HSCR患者的机构记录（LSGC组，n = 52；LCEPC组，n = 31）。在本研究中，我们比较了两组的术后并发症和排便功能。所有患者均进行了随访（1 - 5年，平均2年）。
两组之间手术时间和住院时间无差异，而LCEPC组的肛门解剖时间（22.4±4.8分钟）短于LSGC组（45.5±7.5分钟）（P < 0.001）。LCEPC组有6例患者（19.4%）术后污粪并发症显著增加，而LSGC组有2例患者（3.8%）（P = 0.021）。然而，LCEPC组小肠结肠炎的总发生率（2例患者，6.5%）与LSGC组（12例患者，23.1%）相比显著降低（P = 0.050）。对于吻合口狭窄、肌袖感染和便秘，两组之间无显著差异。本研究中无患者术后出现膀胱麻痹和尿失禁。直肠肛管测压显示，LCEPC组的直肠肛管静息压（14.8±2.7 mmHg）显著低于LSGC组（22.0±3.8 mmHg）（P < 0.001）。
腹腔镜后肌袖完全切除术方法被证明是安全有效的，小肠结肠炎的发生率降低，尽管由于部分肛门内括约肌被切断，可能会在术后短期内增加污粪事件的发生次数。
