Prospective analysis of primary modified Georgeson’s laparoscopy-assisted endorectal pull-through for Hirschsprung’s disease: short- to mid-term results

Abstract

The aim of this study was to analyze the short- to mid-term outcome of primary modified Georgeson's laparoscopy-assisted endorectal pull-through (PMGLEPT) for Hirschsprung's disease (HD). HD patients treated by PMGLEPT were evaluated prospectively by a single surgeon using a standard structured questionnaire to assess complications, incidence of enterocolitis, and evaluate continence (CE). CE involved scoring five parameters (frequency of motions, severity of staining/soiling, severity of perianal erosions, anal shape, and requirement for medications) on a 3-point scale (0, 1, and 2 for each parameter). Thus, scores for CE were: 10 = normal, 8-9 = good, 6-7 = fair, and 0-5 = poor. Our modifications include transanal rectal dissection starting below or on the dentate line, near total excision of the posterior rectal cuff, and intraoperative acetylcholinesterase staining to accurately identify normal colon. Patients with total colon aganglionosis or trisomy-21 were excluded, leaving 33 cases of PMGLEPT performed between 1997 and 2004. Mean operative age was 11.0 months. Follow-up ranged from 8 months to 7 years (mean 4.0 years). There were no intraoperative complications. Post-PMGLEP, bowel obstruction occurred in 1 subject who required middle colic division for pull-through (PT), and enterocolitis occurred in 3 (9.1%) of 33 patients. In 20 subjects aged over 3 years with a follow-up period of more than 12 months, final CE was normal in 5, good in 10, fair in 4, and poor in 1, despite staining/soiling being present in 12 (60%) of 20 subjects. None of the 33 had constipation. Our results suggest that PMGLEPT is safe with acceptable outcome in the short- to mid-term. However, careful long-term follow-up is mandatory as there appears to be a relatively high incidence of staining/soiling on short- to mid-term follow-up.

Laparoscopic-assisted pull-through operation for Hirschsprung’s disease: a systematic review and meta-analysis

“…With regard to faecal incontinence, it is of utmost importance that the anastomosis is not too low or the sphincter is not overstretched during the pull-through operation [17]. Numerous modifications of the coloanal anastomosis have been introduced for the treatment of HD, such as a V-shaped partial resection of the muscular cuff [9], short rectal muscular sleeve [18], Duhamel procedure with Z-shaped anastomosis [19] or modified Georgeson pull-through [20]. These modifications could have a potential impact on the long-term functional aspect in patients with Hirschsprung's disease, although results from these studies are similar regarding bowel function.…”

A comparative study of laparoscopy-assisted pull-through and open pull-through for Hirschsprung's disease with special reference to postoperative fecal continence

“…Our LPT is a modification of Georgeson's PT, which is described elsewhere [2,8]. Briefly, laparoscopic dissection of the rectum distal to the peritoneal reflection is performed laterally and posteriorly, but not anteriorly, to prevent injury to the urethral sphincter nerve plexus.…”

“…Superior rectal or sigmoid vessels are divided laparoscopically if necessary. After preparing ganglionic colon for PT, near full-thickness rectal dissection is performed transanally in the plane of the rectal muscle layer cranially 15 mm from the dentate line [2], taking great care not to injure the superficial external anal sphincter, to release internal anal sphincter achalasia. The plane of dissection is then changed to between the rectal mucosa and the rectal muscle layers and continued proximally.…”

Comparison of transanal endorectal pull-through and laparoscopic assisted transanal endorectal pull-through for Hirschsprung's disease

“…Ishihara ve ark. (13) tarafın-dan yapılan çalışmada LYTEP yöntemi kullanılmış, 3 yaşın üstündeki 20 hastada fonksiyonel sonuçların yalnızca 1 hastada zayıf olduğu ve hastaların hiçbi-rinde konstipasyon görülmediği bildirilmiştir. Antao ve Roberts'ın çalışmasında (3) ortalama 12 aylık takip süresinde soiling, fekal inkontinans ya da konstipasyon oluşmamıştır.…”