Pediatric Surgery Unit, Department of Woman, Child, General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples.
Pediatric Unit, Department of Woman, Child, and General and Specialized Surgery, University of Campania Luigi Vanvitelli, Naples.
Pediatr Med Chir. 2024 Jul 4;46(2). doi: 10.4081/pmc.2024.333.
The main advantage of the laparo-assisted transanal endorectal pull-through technique (LA - TERPT) for Hirschsprung Disease (HD) is the respect to the rectal-anal anatomy. Postoperative complications have been observed recently. The present study aims to determine how often these postoperative complications occur in these patients. From January 2009 to December 2018, a retrospective analysis was conducted on 36 children (25 males) with HD who underwent LA-TERPT. Data were collected on the age of diagnosis and surgery, sex, the presence of other pathologies, and cases of enterocolitis. In all cases, anorectal manometry (ARM) was performed to evaluate the anal tone. The median age at diagnosis was 2 months and the mean age at surgery was 5 months. Nine related pathologies were identified: five cases of Down syndrome, one case of hypertrophic stenosis of the pylorus, atresia of the esophagus, polydactyly, and anorectal malformation. A patient with total colonic aganglionosis was identified through laparoscopic serummuscular biopsies. Enterocolitis was diagnosed in 7 cases before and 6 after surgery. At follow-up, the complications recorded were: 5 cases of constipation (treated with fecal softeners), one case of anal stenosis (patient with anorectal malformation), 16 cases of soiling (treated with enemas) and 1 child with fecal incontinence (treated with a transanal irrigation system). The ARM was performed in all 36 cases and showed normal anal tone, except for one case with anal hypotonia. LA-TERPT is an important surgical technique for HD. According to the literature, soiling is the most main complication after HD surgery, probably due to "pseudo-incontinence" with normal anal sphincter tone.
经肛内拖出术治疗先天性巨结肠的主要优势在于它尊重直肠肛门解剖学。最近观察到术后并发症。本研究旨在确定这些患者术后并发症的发生频率。从 2009 年 1 月至 2018 年 12 月，对 36 例（男 25 例）先天性巨结肠患儿行经肛内拖出术（LA-TERPT）进行回顾性分析。收集了诊断和手术时的年龄、性别、是否存在其他病变以及肠炎的发生情况。所有病例均行肛门直肠测压（ARM）评估肛门张力。诊断时的中位年龄为 2 个月，手术时的平均年龄为 5 个月。共发现 9 种相关病变：5 例唐氏综合征，1 例肥厚性幽门狭窄，食管闭锁，多指畸形和肛门直肠畸形。1 例全结肠无神经节细胞症通过腹腔镜血清肌活检确诊。7 例在术前和 6 例在术后诊断为肠炎。随访时记录的并发症包括：5 例便秘（用粪便软化剂治疗），1 例肛门狭窄（肛门直肠畸形患者），16 例大便失禁（用灌肠治疗）和 1 例大便失禁（用经肛门灌洗系统治疗）。所有 36 例均行 ARM 检查，除 1 例肛门张力低外，其余均正常。LA-TERPT 是先天性巨结肠的重要手术方法。根据文献，肠炎是先天性巨结肠手术后最主要的并发症，可能是由于“假性失禁”和正常的肛门括约肌张力。
