Gołębiewski Andrzej, Anzelewicz Stefan, Sosińska Daria, Osajca-Kanyion Monika
Department of Surgery and Urology for Children and Adolescents, Medical University of Gdansk, 80-210 Gdansk, Poland.
University Clinical Centre in Gdansk, 80-952 Gdansk, Poland.
Children (Basel). 2024 Aug 29;11(9):1059. doi: 10.3390/children11091059.
BACKGROUND/OBJECTIVES: Hirschsprung's disease (HD) is a congenital disorder characterised by the absence of ganglion cells in the distal bowel, resulting in functional obstruction. The transanal endorectal pull-through (TEPT) procedure, a minimally invasive approach, aims to treat HD by removing the aganglionic segment. This study assessed the feasibility, safety, and efficacy of single-stage TEPT in paediatric patients, focusing on postoperative complications, bowel function, and quality of life.
A retrospective cohort study was conducted on 150 children who underwent single-stage TEPT from January 2005 to December 2023 at the Medical University of Gdansk. Data were collected from medical records, including demographics, preoperative assessments, surgical details, postoperative management, and follow-up outcomes. Statistical analyses were performed using Microsoft Excel 365 and the programming language Python 3.12. The mean age at surgery was 13 months, with a male-to-female ratio of 2.75:1. The mean operative time was 129 min, and the mean hospital stay was seven days.
Postoperative complications included anastomotic leak (4%), wound infections (15%), and enterocolitis (26%). Redo surgeries were required in 18% of cases due to persistent constipation and obstructive symptoms. This article includes a comprehensive review of the literature.
TEPT demonstrates a favourable safety profile and efficacy in treating HD, though significant concerns include complications such as enterocolitis and the need for additional surgeries. Surgical expertise and thorough preoperative and postoperative management are crucial to optimising patient outcomes.
背景/目的：先天性巨结肠（HD）是一种先天性疾病，其特征是远端肠道缺乏神经节细胞，导致功能性梗阻。经肛门直肠拖出术（TEPT）是一种微创手术方法，旨在通过切除无神经节段来治疗HD。本研究评估了单阶段TEPT在儿科患者中的可行性、安全性和有效性，重点关注术后并发症、肠道功能和生活质量。
对2005年1月至2023年12月在格但斯克医科大学接受单阶段TEPT的150名儿童进行了一项回顾性队列研究。从病历中收集数据，包括人口统计学、术前评估、手术细节、术后管理和随访结果。使用Microsoft Excel 365和编程语言Python 3.12进行统计分析。手术时的平均年龄为13个月，男女比例为2.75:1。平均手术时间为129分钟，平均住院时间为7天。
术后并发症包括吻合口漏（4%）、伤口感染（15%）和小肠结肠炎（26%）。由于持续便秘和梗阻症状，18%的病例需要再次手术。本文包括对文献的全面综述。
TEPT在治疗HD方面显示出良好的安全性和有效性，尽管重大问题包括小肠结肠炎等并发症以及需要额外手术。手术专业知识以及全面的术前和术后管理对于优化患者预后至关重要。
