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.

Abstract

Central line catheterisation plays a crucial role in prolonged treatment in children. Totally implantable venous access devices (TIVADs) are associated with a lower risk of thrombosis and are perceived by patients as more comfortable to use. The catheterisation is most commonly performed through the internal jugular vein or the subclavian vein. The present article shows the cases of two patients in whom atypical placement of a TIVAD was used. The first patient underwent TIVAD placement via femoral vein due to tumour mass in the thoracic cavity and thrombotic stenosis of both jugular and subcostal veins. In the second case, atypical localisation applied to the placement of a reservoir in the left parasternal region. In both patients, the atypical placement of TIVAD resulted in prolonged patency and provided access for further treatment.

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