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One-stage Soave pull-through for Hirschsprung's disease: a comparison of the transanal and open approaches.
J Pediatr Surg. 2000 Jun; 35(6):820-2.JP

Abstract

PURPOSE

The authors reviewed their experience using the transanal Soave technique, to determine (1) if it offers any advantages over the standard open approach and (2) whether routine laparoscopic visualization is necessary.

METHODS

The case reports of 37 consecutive children less than 3 years old undergoing Soave pull-through were reviewed. Patients were excluded from analysis if they had total colon disease or had a previous colostomy. The patients were divided into 3 groups: open Soave (OS, n = 13), transanal Soave with routine laparoscopic visualization (LVS, n = 9), and transanal Soave with selective laparoscopy or minilaparotomy (TAS, n = 15). Cost was calculated based on hospital stay, operating room time, and use of laparoscopic equipment.

RESULTS

In the TAS group, suspicion of a longer segment led to the selective use of laparoscopy with or without biopsy in 2 children, and the use of a small umbilical incision for mobilization of the splenic flexure in 2. There were no differences among groups with respect to age, weight, gender, transition zone, operating time, blood loss, intraoperative complications, enterocolitis, or stricture or cuff narrowing. Hospital stay was significantly longer in the OS group (median, 7 days; range, 3 to 47) than the LVS (median, 1; range 1 to 6) or TAS (median, 1, range, 1 to 3) groups. Cost (in thousands of dollars) was also higher in the OS group (median, 6.9; range, 3.9-25.7) than the LVS (median, 3.9; range, 3.6 to 6.4) or TAS (median, 3.4; range, 2.2 to 9.4) groups. Repeat surgery was necessary for 4 OS patients: 2 adhesive small bowel obstructions (1 of whom died), 1 twisted pull-through, and 1 recurrent aganglionosis. Three TAS patients required repeat surgery: 1 twisted pull-through, 1 anastomotic leak, and 1 cuff narrowing.

CONCLUSIONS

These data suggest that the transanal pull-through is associated with a significantly shorter hospital stay and lower cost than the open approach, without an increased risk of complications. Because there is no intraabdominal dissection, there probably is a lower incidence of adhesive bowel obstruction. Routine laparoscopic visualization or minilaparotomy is not necessary but should be used in children who are at higher risk for long segment disease.

Authors+Show Affiliations

Division of Pediatric Surgery, Washington University School of Medicine, St Louis, Missouri, USA.No affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

10873018

Citation

Langer, J C., et al. "One-stage Soave Pull-through for Hirschsprung's Disease: a Comparison of the Transanal and Open Approaches." Journal of Pediatric Surgery, vol. 35, no. 6, 2000, pp. 820-2.
Langer JC, Seifert M, Minkes RK. One-stage Soave pull-through for Hirschsprung's disease: a comparison of the transanal and open approaches. J Pediatr Surg. 2000;35(6):820-2.
Langer, J. C., Seifert, M., & Minkes, R. K. (2000). One-stage Soave pull-through for Hirschsprung's disease: a comparison of the transanal and open approaches. Journal of Pediatric Surgery, 35(6), 820-2.
Langer JC, Seifert M, Minkes RK. One-stage Soave Pull-through for Hirschsprung's Disease: a Comparison of the Transanal and Open Approaches. J Pediatr Surg. 2000;35(6):820-2. PubMed PMID: 10873018.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - One-stage Soave pull-through for Hirschsprung's disease: a comparison of the transanal and open approaches. AU - Langer,J C, AU - Seifert,M, AU - Minkes,R K, PY - 2000/6/29/pubmed PY - 2000/10/21/medline PY - 2000/6/29/entrez SP - 820 EP - 2 JF - Journal of pediatric surgery JO - J Pediatr Surg VL - 35 IS - 6 N2 - PURPOSE: The authors reviewed their experience using the transanal Soave technique, to determine (1) if it offers any advantages over the standard open approach and (2) whether routine laparoscopic visualization is necessary. METHODS: The case reports of 37 consecutive children less than 3 years old undergoing Soave pull-through were reviewed. Patients were excluded from analysis if they had total colon disease or had a previous colostomy. The patients were divided into 3 groups: open Soave (OS, n = 13), transanal Soave with routine laparoscopic visualization (LVS, n = 9), and transanal Soave with selective laparoscopy or minilaparotomy (TAS, n = 15). Cost was calculated based on hospital stay, operating room time, and use of laparoscopic equipment. RESULTS: In the TAS group, suspicion of a longer segment led to the selective use of laparoscopy with or without biopsy in 2 children, and the use of a small umbilical incision for mobilization of the splenic flexure in 2. There were no differences among groups with respect to age, weight, gender, transition zone, operating time, blood loss, intraoperative complications, enterocolitis, or stricture or cuff narrowing. Hospital stay was significantly longer in the OS group (median, 7 days; range, 3 to 47) than the LVS (median, 1; range 1 to 6) or TAS (median, 1, range, 1 to 3) groups. Cost (in thousands of dollars) was also higher in the OS group (median, 6.9; range, 3.9-25.7) than the LVS (median, 3.9; range, 3.6 to 6.4) or TAS (median, 3.4; range, 2.2 to 9.4) groups. Repeat surgery was necessary for 4 OS patients: 2 adhesive small bowel obstructions (1 of whom died), 1 twisted pull-through, and 1 recurrent aganglionosis. Three TAS patients required repeat surgery: 1 twisted pull-through, 1 anastomotic leak, and 1 cuff narrowing. CONCLUSIONS: These data suggest that the transanal pull-through is associated with a significantly shorter hospital stay and lower cost than the open approach, without an increased risk of complications. Because there is no intraabdominal dissection, there probably is a lower incidence of adhesive bowel obstruction. Routine laparoscopic visualization or minilaparotomy is not necessary but should be used in children who are at higher risk for long segment disease. SN - 0022-3468 UR - https://www.unboundmedicine.com/medline/citation/10873018/One_stage_Soave_pull_through_for_Hirschsprung's_disease:_a_comparison_of_the_transanal_and_open_approaches_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0022-3468(00)91210-7 DB - PRIME DP - Unbound Medicine ER -