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A comparative study of laparoscopy-assisted pull-through and open pull-through for Hirschsprung's disease with special reference to postoperative fecal continence.
- Source :
-
Journal of pediatric surgery [J Pediatr Surg] 2007 Dec; Vol. 42 (12), pp. 2071-4. - Publication Year :
- 2007
-
Abstract
- Aim: The objective of this study is to compare laparoscopy-assisted pull-through (LPT) and open pull-through (OPT) for Hirschsprung's disease with special reference to postoperative fecal continence.<br />Methods: Thirteen OPT patients (1991-1996) were reviewed retrospectively, and 22 LPT (1997-2002) were reviewed prospectively. A continence evaluation questionnaire (CEQ, max score = 10) assessing frequency of motions, severity of staining, severity of perianal erosions, anal shape, and requirement for medications was used. Severity of staining was graded as none = 2, occasional = 1.5, often = 1, always = 0.5, and soiling = 0, and severity of staining less than or equal to 1 was defined as moderate to severe incontinence. Presence of fever (peak and duration), raised white cell count (>10,000/microL), and C-reactive protein (>0.3 mg/dL) were used to assess surgical stress.<br />Results: Pull-through was endorectal in all cases. Mean age at pull-through was not statistically different between the 2 groups. Annual CEQ scores for 7 years after LPT were 6.3, 6.9, 7.3, 7.7, 8.3, 8.9, and 9.0, and after OPT were 5.6, 6.4, 7.0, 7.5, 7.8, 8.3, and 8.4. Although CEQ scores were higher after LPT throughout, the difference was not statistically significant. The incidence of moderate to severe incontinence after 4 years was 54% (7/13) for OPT and 23% (5/22) for LPT, and after 6 years, it was 23% (3/13) for OPT and 0% for LPT. Duration/peak of raised C-reactive protein and duration of fever were significantly less for LPT (P < .01).<br />Conclusion: Our results suggest that LPT is less invasive and may provide better postoperative bowel management compared with OPT.
- Subjects :
- Anastomosis, Surgical methods
Defecation physiology
Female
Follow-Up Studies
Hirschsprung Disease diagnosis
Humans
Infant
Male
Minimally Invasive Surgical Procedures methods
Pain, Postoperative physiopathology
Postoperative Complications diagnosis
Probability
Retrospective Studies
Risk Factors
Sensitivity and Specificity
Treatment Outcome
Colectomy methods
Fecal Incontinence prevention & control
Hirschsprung Disease surgery
Laparoscopy methods
Subjects
Details
- Language :
- English
- ISSN :
- 1531-5037
- Volume :
- 42
- Issue :
- 12
- Database :
- MEDLINE
- Journal :
- Journal of pediatric surgery
- Publication Type :
- Academic Journal
- Accession number :
- 18082710
- Full Text :
- https://doi.org/10.1016/j.jpedsurg.2007.08.033