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Byström C, Östlund S, Hoff N, Wester T, Granström AL. Evaluation of Bowel Function, Urinary Tract Function, and Quality of Life after Transanal Endorectal Pull-Through Surgery for Hirschsprung's Disease. Eur J Pediatr Surg 2021; 31:40-48. [PMID: 32877942 DOI: 10.1055/s-0040-1715612] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION The objective of this study is to determine short-term complications and evaluate long-term bowel function, lower urinary tract symptoms, and quality of life (QoL) in patients treated for Hirschsprung's disease (HSCR) with transanal endorectal pull-though (TERPT) compared with healthy controls. MATERIALS AND METHODS This cross-sectional case-control study included 30 HSCR patients treated with TERPT in 2006 to 2014 at Karolinska University Hospital, and 30 healthy controls matched for age and gender. Data on short-term complications were compiled from medical records and classified according to Clavien-Dindo. Bowel function and QoL were evaluated with the validated questionnaires bowel function score and KIDSCREEN-52. Lower urinary tract symptoms were evaluated through an 8-item lower urinary tract symptoms (LUTS) questionnaire. RESULTS Six (20%) patients had a short-term postoperative complication according to Clavien-Dindo, with insufficient pain management being the most common complication. The median age at follow-up was 7 years (range = 4-11). Median bowel function score was significantly lower in HSCR patients than in controls, 14 versus 19 (p < 0.001). Twenty-one of the HSCR patients reported impaired bowel function compared with two of the controls (p < 0.001). The overall prevalence of LUTS was 11 (38%) in the HSCR patients compared with seven (23%) in the controls (p = 0.751). HSCR patients reported a slightly lower QoL in the KIDSCREEN domain "financial resources" compared with controls (p = 0.008). CONCLUSION According to Clavien-Dindo, short-term postoperative complications occurred in 20% of the patients. Impaired bowel function persists throughout childhood for most HSCR patients. The prevalence of LUTS and QoL is not affected in HSCR patients compared with controls.
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Affiliation(s)
- Cornelia Byström
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden, Sweden
| | - Sanna Östlund
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden, Sweden
| | - Nils Hoff
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden, Sweden
| | - Tomas Wester
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden, Sweden
| | - Anna Löf Granström
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden, Sweden
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Lamoshi A, Ham PB, Chen Z, Wilding G, Vali K. Timing of the definitive procedure and ileostomy closure for total colonic aganglionosis HD: Systematic review. J Pediatr Surg 2020; 55:2366-2370. [PMID: 32106964 DOI: 10.1016/j.jpedsurg.2020.02.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 01/02/2020] [Accepted: 02/03/2020] [Indexed: 01/10/2023]
Abstract
AIM To establish the cogency of recommendations for the appropriate age for pull-through and ileostomy closure in Total Colonic Aganglionosis-Hirschsprung Disease's (TCA-HD). METHOD Medline, PubMed, Cochrane, and the ClinicalKey databases were searched without date restriction. The studies that reported TCA-HD cases were evaluated for the number of cases, age at the definitive procedure, age at the ileostomy closure, reported complications, and the type of procedure. Perianal excoriation and diaper rash rates were analyzed using SPSS software, with p < 0.05 considered significant. RESULTS Twenty-five studies mentioned TCA-HD findings between 1968 and 2019. The total number of patients who had definitive surgery was 218. Analysis showed no correlation between development of diaper rash and the age of the patient at the time of the definitive surgery or ileostomy closure. Studies scored between six and nine of nine possible stars on the NOS scoring system. CONCLUSION There is no correlation between age of surgery and postoperative diaper rash. Delaying the definitive procedure or ileostomy closure for TCA-HD has limited support on a review of current studies. The perianal excoriation/diaper rash is not reported in the literature at a high enough frequency to warrant keeping a diverting ileostomy until toilet trained of urine. TYPE OF STUDY Systematic review and meta-analysis. Levels of evidence IV.
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Affiliation(s)
- Abdulraouf Lamoshi
- Department of Pediatric Surgery, John R. Oishei Children's Hospital, Buffalo, NY.
| | - P Benson Ham
- Department of Pediatric Surgery, John R. Oishei Children's Hospital, Buffalo, NY
| | - Z Chen
- Department of Biostatistics, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY
| | - G Wilding
- Department of Biostatistics, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY
| | - Kaveh Vali
- Department of Pediatric Surgery, John R. Oishei Children's Hospital, Buffalo, NY
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Ademuyiwa AO, Elebute OA, Balogun OS, Desalu I, Chirdan LB, Bode CO. Laparoscopy-assisted Transanal Endorectal Pull-through for the Management of Hirschsprung's Disease in Nigeria: Report of Two Cases. Niger J Surg 2020; 26:78-80. [PMID: 32165842 PMCID: PMC7041351 DOI: 10.4103/njs.njs_39_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2018] [Revised: 10/19/2018] [Accepted: 11/18/2018] [Indexed: 11/04/2022] Open
Abstract
Hirschsprung's disease is a relatively common disease in pediatric colorectal surgery. The treatment modalities have evolved from third-stage to single-stage in the past three decades. The single-stage procedure can be performed using the open, transanal or laparoscopy-assisted techniques. We use these cases to illustrate the first laparoscopically assisted procedures for Hirschsprung's disease in our center. The laparoscopic-assisted technique is described, and lessons in collaboration across institutions and within institutions are discussed.
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Affiliation(s)
- Adesoji O Ademuyiwa
- Department of Surgery, Paediatric Surgery Unit, College of Medicine, University of Lagos and Lagos University Teaching Hospital, Idi Araba, Lagos, Nigeria
| | - Olumide A Elebute
- Department of Surgery, Paediatric Surgery Unit, College of Medicine, University of Lagos and Lagos University Teaching Hospital, Idi Araba, Lagos, Nigeria
| | - Olanrewaju S Balogun
- Department of Surgery, General Surgery Unit (Minimal Access Surgery), College of Medicine, University of Lagos and Lagos University Teaching Hospital, Idi Araba, Lagos, Nigeria
| | - Ibironke Desalu
- Department of Anaesthesia, College of Medicine, University of Lagos and Lagos University Teaching Hospital, Idi Araba, Lagos, Nigeria
| | - Lohfa B Chirdan
- Department of Surgery, Division of Paediatric Surgery, University of Jos and Jos University Teaching Hospital, Jos, Plateau State, Nigeria
| | - Christopher O Bode
- Department of Surgery, Paediatric Surgery Unit, College of Medicine, University of Lagos and Lagos University Teaching Hospital, Idi Araba, Lagos, Nigeria
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Bawazir OA. Laparoscopic-Assisted Transanal Pull-Through in Hirschsprung Disease: Does Laparoscopic Dissection Minimize Anal Overstretching? J Laparoendosc Adv Surg Tech A 2020; 30:338-343. [PMID: 31934817 DOI: 10.1089/lap.2019.0524] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Introduction: Surgical treatment for Hirschsprung disease (HD) has evolved from a staged repair to a primary operation but is still associated with significant complications. Extensive transanal dissection may overstretch the sphincter and cause partial tear; however, laparoscopic dissection can decrease rectal overstretching. Thus, this study aimed to evaluate the outcome of surgical management of HD and the efficacy of laparoscopic-assisted transanal endorectal pull-through in infants and children in our center. Patients and Methods: We reviewed the medical records of 74 patients who underwent surgical repair of HD from 2006 to 2019. However, we excluded 42 patients with HD (patients with stoma [n = 33] and total colonic aganglionosis [n = 9]). The remaining 32 patients were divided into two groups. Group A included patients who had transanal pull-through with laparoscopic assistance only to visualize the transition zone, take a biopsy, and check for twisting or bleeding. Group B included patients who had laparoscopic-assisted transanal pull-through with dissection of the rectum. All patients had Soave repair with an approximate cuff length of 5 cm. Results: Group A included 18 patients, whereas group B included 14 patients. Demographic data were comparable between the two groups with no significant difference in age or gender (P = .12 and .67, respectively). Patients in group A had longer operative time (210 ± 20.75 minutes versus 178 ± 18.92 minutes; P < .001) and hospital stay (6 ± 1.33 days versus 5 ± 1.24 days; P = .033). No significant difference was observed in postoperative complications between both groups (anastomotic site stricture, P = .295; persistent soiling, P = .238). Conclusion: Laparoscopic rectal dissection for managing HD is associated with less operative time and hospital stay. In addition, all procedures required for the repair can be safely performed using laparoscopy.
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Affiliation(s)
- Osama A Bawazir
- Pediatric Surgery and Pediatric Urology, Umm Al-Qura University Faculty of Medicine, King Faisal Specialist Hospital and Research Centre, Jeddah, Saudi Arabia
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Bing X, Sun C, Wang Z, Su Y, Sun H, Wang L, Yu X. Transanal pullthrough Soave and Swenson techniques for pediatric patients with Hirschsprung disease. Medicine (Baltimore) 2017; 96:e6209. [PMID: 28272213 PMCID: PMC5348161 DOI: 10.1097/md.0000000000006209] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Both the Swenson and the Soave procedures have been adapted as transanal approaches. Our purpose is to compare the outcomes and complications between transanal Swenson and Soave procedures.This clinical analysis involved a retrospective series of 148 pediatric patients with HD from Dec, 2001, to Dec, 2015. Perioperative/operative characteristics, postoperative complications, and outcomes between the 2 groups were analyzed. Students' t-test and chi-squared analysis were performed.In total 148 patients (Soave 69, Swenson 79) were included in our study. Mean follow-up was 3.5 years. There are no significant differences in overall hospital stay and bowel function. We noted significant differences regarding mean operating time, blood loss, and overall complications. We noted significant differences in mean operating time, blood loss, and overall complications in favor of the Swenson group when compared to the Soave group (P < 0.05).According to our results, although transanal pullthrough Swenson cannot reduce overall hospital stay and improve bowel function compared with the Soave procedure, it results in less blood loss, shorter operation time, and a lower complication rate.
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Abstract
Parents often perceive infant gastroesophageal reflux (GER) as a serious problem. Frequently, GER is explained as a normal process, but there are instances where parents’ concerns are valid. Provided are 3 case studies from the private practice of an IBCLC. Each case initially presented with what sounded like normal infant GER. Upon further evaluation, with close follow-up and more detailed history taking, each case required advanced medical attention. These cases highlight the unique role of the IBCLC in helping to assess GER, the value of working as a team member with baby’s physicians, and the importance of listening carefully to parental instincts and concerns.
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Wittmeier K, Holland C, Hobbs-Murison K, Crawford E, Beauchamp C, Milne B, Morris M, Keijzer R. Analysis of a parent-initiated social media campaign for Hirschsprung's disease. J Med Internet Res 2014; 16:e288. [PMID: 25499427 PMCID: PMC4275490 DOI: 10.2196/jmir.3200] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2014] [Revised: 06/07/2014] [Accepted: 08/17/2014] [Indexed: 12/03/2022] Open
Abstract
Background Social media can be particularly useful for patients or families affected by rare conditions by allowing individuals to form online communities across the world. Objective Our aim in this study was to conduct a descriptive and quantitative analysis of the use of a social media community for Hirschsprung’s Disease (HD). Methods In July 2011, a mother of a child with HD launched the “Shit Happens” campaign. The campaign uses social media (blogs, Twitter, and Facebook) to engage other families affected by HD. Internet analytics including Google Analytics and Facebook Insights were used to evaluate the reach and responsiveness of this campaign. Results On the day the HD campaign was launched, 387 people viewed the blog “Roo’s Journey”. Blog views have now exceeded 5400 views from 37 countries. The Facebook page extends to 46 countries, has an average post reach of 298 users, 1414 “likes”, and an overall reach of 131,032 users. The campaign has 135 Twitter followers and 344 tweets at the time of writing. The most common question posted on the Facebook page is related to treatment for extreme diaper rash. Responsiveness assessment demonstrated that within 2 hours of posting, a question could receive 143 views and 20 responses, increasing to 30 responses after 5 hours. Conclusions Social media networks are well suited to discussion, support, and advocacy for health-related conditions and can be especially important in connecting families affected by rare conditions. The HD campaign demonstrates the reach and responsiveness of a community that primarily relies on social media to connect families affected by HD. Although responsive, this community is currently lacking consistent access to evidence-based guidance for their common concerns. We will explore innovative consumer-researcher partnerships to offer a solution in future research.
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Affiliation(s)
- Kristy Wittmeier
- Centre for Healthcare Innovation, University of Manitoba, Winnipeg Regional Health Authority, Winnipeg, MB, Canada
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Mathur MK, Aggarwal SK, Ratan SK, Sinha SK. Laparoscopic-assisted transanal pull-through for Hirschsprung's disease: Comparison between partial and near total laparoscopic mobilization of rectum. J Indian Assoc Pediatr Surg 2014; 19:70-5. [PMID: 24741208 PMCID: PMC3983770 DOI: 10.4103/0971-9261.129596] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background: Transanal pull-through with laparoscopic assistance is gaining popularity. How much rectal dissection to do laparoscopically and how much transanally is not clear. Laparoscopic rectal mobilization is akin to open pelvic dissection of Swenson's operation — the most physiological procedure. Through this comparative study, we aim to evolve a technique that maximizes the benefits of Swenson's technique and minimizes the problems of a transanal procedure. Materials and Methods: Twenty patients (19 boys and one girl, newborn to 6 years) with Hirschsprung's disease (HD) were randomized for laparoscopic-assisted transanal pull-through (LATAPT) either by near complete (Group A) or partial (Group B) laparoscopic mobilization of rectum. Patients were followed up for at least 3 months. Demographic profile; operative details (time taken, blood loss, operative difficulty, and complications); postoperative course (duration of urinary catheter, oral feeding, and hospital stay); and follow-up stooling pattern, consistency, and continence were compared in the two groups. Results: The time taken for laparoscopic mobilization was marginally higher in group A, but the time taken for transanal dissection in this group was significantly less than in group B. All other comparisons showed no significant difference in the two groups. Stool frequency and continence improved with time in both groups. Conclusion: Extent of laparoscopic mobilization of rectum does not appear to be a factor deciding the outcomes. No recommendations could be made in view of the small number of cases. However, it shows that laparoscopic assistance can be used to maximize the benefits of Swenson type of operation and a transanal pull-through.
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Affiliation(s)
- Mohit Kumar Mathur
- Senior Resident of Paediatric Surgery, Maulana Azad Medical College, New Delhi, India ; Senior Resident at Chacha Nehru Bal Chikitsalaya, New Delhi, India
| | - Satish Kumar Aggarwal
- Senior Resident of Paediatric Surgery, Maulana Azad Medical College, New Delhi, India
| | - Simmi K Ratan
- Senior Resident of Paediatric Surgery, Maulana Azad Medical College, New Delhi, India
| | - Shandip Kumar Sinha
- Senior Resident of Paediatric Surgery, Maulana Azad Medical College, New Delhi, India
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Krishnamohan J, Senthilnathan VS, Vaikundaraman TM, Srinivasan T, Balamurugan M, Iwasaki M, Preethy S, Abraham SJK. In vitro culture and characterization of enteric neural precursor cells from human gut biopsy specimens using polymer scaffold. Intractable Rare Dis Res 2013; 2:98-102. [PMID: 25343111 PMCID: PMC4204546 DOI: 10.5582/irdr.2013.v2.3.98] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Revised: 08/09/2013] [Accepted: 08/12/2013] [Indexed: 11/05/2022] Open
Abstract
In vitro expansion and characterization of neural precursor cells from human gut biopsy specimens with or without Hirschsprung's disease using a novel thermoreversible gelation polymer (TGP) is reported aiming at a possible future treatment. Gut biopsy samples were obtained from five patients undergoing gut resection for Hirschsprung's disease (n = 1) or gastrointestinal disorders (n = 4). Cells isolated from the smooth muscle layer and the myenteric plexus were cultured in two groups for 18 to 28 days; Group I: conventional culture as earlier reported and Group II: using TGP scaffold. Neurosphere like bodies (NLBs) were observed in the cultures between 8th to 12th day and H & E staining was positive for neural cells in both groups including aganglionic gut portion from the Hirschsprung's disease patient. Immunohistochemistry using S-100 and neuron specific enolase (NSE) was positive in both groups but the TGP group (Group II) showed more number of cells with intense cytoplasmic granular positivity for both NSE and S-100 compared to Group I. TGP supports the in vitro expansion of human gut derived neuronal cells with seemingly better quality NLBs. Animal Studies can be tried to validate their functional outcome by transplanting the NLBs with TGP scaffolds to see whether this can enhance the outcome of cell based therapies for Hirschsprung's disease.
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Affiliation(s)
- Janardhanam Krishnamohan
- Department of Paediatric Surgery, Madras Medical College, E.V.R Periyar Salai, Park Town, Chennai, India
- Department of Paediatric Surgery, Government Kasturba Gandhi Hospital, Triplicane, Chennai, India
| | - Venugopal S Senthilnathan
- Department of Paediatric Surgery, Institute of Child Health & Hospital for Children, Egmore, Chennai, India
| | | | - Thangavelu Srinivasan
- The Fujio—Eiji Academic Terrain (FEAT), Nichi-In Centre for Regenerative Medicine (NCRM), Nungambakkam, Chennai, India
| | | | - Masaru Iwasaki
- Yamanashi University- School of Medicine, Chuo, Yamanashi, Japan
| | - Senthilkumar Preethy
- The Fujio—Eiji Academic Terrain (FEAT), Nichi-In Centre for Regenerative Medicine (NCRM), Nungambakkam, Chennai, India
- Hope Foundation (Trust), Choolaimedu, Chennai, India
| | - Samuel JK Abraham
- The Mary-Yoshio Translational Hexagon (MYTH), Nichi-In Centre for Regenerative Medicine (NCRM), Nungambakkam, Chennai, India
- Yamanashi University- School of Medicine, Chuo, Yamanashi, Japan
- Address correspondence to: Dr. Samuel JK Abraham, The Mary-Yoshio Translational Hexagon (MYTH), Nichi-In Centre for Regenerative Medicine (NCRM), PB 1262, Nungambakkam, Chennai — 600034, Tamil Nadu. India. E-mail: Alternate E-mail:
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