The treatment of Hirschsprung's disease has changed over the past several years. Significant modifications occurred after the implementation of surgery without laparotomy, using transanal access. The type of this surgery depends on the condition and the age of a child. The aim of the study was to summarize our 15-year experience with one-stage surgery for the treatment of Hirschsprung's disease in the wider context of current clinical practice and to identify transanal endorectal pull-through-related factors influencing the surgery and hospitalization. The retrospective analysis of newborns, infants, and young children was performed between 2000 and 2014. Four girls and 29 boys were operated on. The parameters describing the surgery and the hospitalization were analyzed. The number of patients treated using transanal endorectal pull-through technique was 30, and Duhamel-Martin, 3. There were significant correlations (p<0.05) between necessity of blood transfusion, length of resected intestine, operative time, the number of intraoperative histopathological assessments, and length of hospitalization. The time of one-step surgery is extended because of waiting for repeated intraoperative histopathological assessment of the level of resection. More extended bowel resection is connected with longer length of hospitalization and, more often, necessity of blood transfusion.

IntroductionSurgical treatment of Hirschsprung's disease may be performed in a single step, or in stages with a temporary stoma. The therapy depends on the clinical condition of the patient and the severity of symptoms. Planned multistage treatment is carried out in two or three steps.AimTo analyse our 15 years of experience with multistage surgery for the treatment of Hirschsprung's disease, to identify multistage-related factors influencing the course of surgery and hospitalisation, and to evaluate the probability of complications during multistage treatment.Material and methodsThe study material was collected on the basis of documentation of patients treated during the years 2000 to 2014. The parameters concerning surgery and hospitalisation were statistically analysed.ResultsTwenty nine patients were treated with multistage surgery using the following methods: Duhamel-Martin and Transanal Endorectal Pull-Through (TEPT). There were significant correlations (p < 0.05) between length of resected intestine and operative time. Classification and Regression Tree (CRT) was used to classify the operated children depending on the presentence of complications after surgery.ConclusionsThe incidence of complications during multistage treatment for both methods was comparable. It is difficult to objectively compare the Duhamel-Martin and TEPT techniques because of the different indicators for their use in multistage surgery. Intestinal adhesions were the most common complication after definitive surgery. Younger age of the operated patients was associated with greater risk of adhesion formation.

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Low grade fibromyxoid sarcoma (LGFMS) is a rare soft tissue tumor appearing mainly in young adults. Despite its bland histological features, the tumor has a tendency toward late local recurrence and distant metastases even up to 45 years after the diagnosis. The treatment of choice in this type of neoplasm is a radical surgical excision with clear resection margins. We decided to present a case report of a 17-year-old patient with LGFMS of the right hip. Surgical resection of the tumor was performed, but in the histopathological examination was described the minimal resection margin (0.3 mm). The multi-specialist team composed of oncologist, radiologist, and pediatric surgeon based on the literature decided to widen the resection margin despite its obtainment during the primary operation. The scar after the first surgery and surrounding soft tissues with the bigger margin were resected. No evidence of cancerous infiltration was found in the second histopathological material. Patient has stayed under the routine control of pediatric surgeon, pediatric oncologist, and has not presented recurrence for 3 years. In conclusion, when the resection margin is uncertain after the primary surgery, the increase of the range of operation allows the prevention of the late recurrence of the disease.

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