히르슈슈프룽병의일차성복강경보조 Endorectal Pull-Through 술식의임상적고찰 접수일 게재승인일 교신저자 설지영 대전시중구문화로 충남대학교병원외과
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1 히르슈슈프룽병의일차성복강경보조 Endorectal Pull-Through 술식의임상적고찰 접수일 게재승인일 교신저자 설지영 대전시중구문화로 충남대학교병원외과
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4 Table 1. General Patients and Surgical Characteristics Male : female 32 : 10 Mean age at operation (range) 1 month (6 days-4 years) Level of aganglionosis Rectum/rectosigmoid 41 Transverse colon 1 Mean operation time (range) 144 min ( min) Open conversion No Mean length of hospital Stay (range) 6.5 days ( days) Mean time to full feeds (range) 3.8 days ( days) Mean time to spontaneous defecation (range) 1.5 days ( days) Mean follow-up period (range) 45 months (18 86 months)
5 Table 2. Early Postoperative Complications (<3 Months after Surgery) Complications No. of patients (%) Perianal dermatitis 22 (52.4) Early 21 Moderate 1 Severe 0 Anastomotic stricture requiring Hegar dilatation 9 (21.4) Anastomotic leak 0 Enterocolitis 3 ( 7.1) Wound complications 0 Table 3. Late Postoperative Complications and Long-term Outcomes (>3 Months after Surgery) Late complications & long-term outcomes No. of patients (%) Stenosis (not respond to regular Hegar dilatation) 1 ( 2.4) Enterocolitis 6 (18.8) Obstructive symptoms 3 ( 7.1) Need for laxatives 11 (26.2)
6 Table 4. Functional Results of Krickenbeck Assessment (N=32 Patients >3 Years Old) VBM* Soiling Constipation + Yes/total (%) 32 (100) 5 (15.6) 6 (18.8) Grade 1 3 ( 9.3) 2 ( 6.3) Grade 2 2 ( 6.3) 4 (12.5) Grade *Voluntary bowel movement: feeling of urge, capacity to verbalize, hold the bowel movement Soiling: Grade 1 occasionally (once or twice per week); Grade 2 every day, no social problem; Grade 3 constant, social problem + Constipation: Grade 1 manageable with diet; Grade 2 requires laxatives; Grade 3 resistant to diet and laxatives
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8 1. Teitelbaum DH: Hirschsprung's disease, in: O'Neill JA Jr, Grosfeld JL, Fonkalsrud EW, Coran AG, Caldamone AA (eds): Principles of Pediatric Surgery(ed 2) St. Louis, Mosby, 2004, Pp Gunnarsdóttir A, Wester T: Modern Treatment of Hirschsprung s disease. Scand J Surg 100: , Swenson O: Hirschsprung's disease a complicated therapeutic problem: some thoughts and solutions based on data and personal experience over 56 years. J Pediatr Surg 39: , Chatoorgoon K, Pena A, Lawal TA, Levitt M: The Problematic Duhamel Pouch in Hirschsprung s disease: manifestations and treatment. Eur J Pediatr Surg 21: , Soave F: A new surgical technique for the treatment of Hirschsprung s disease. Surgery 56: , Haricharan RN, Georgeson KE: Hirschsprug disease. Semin Pediatr Surg 17: , Doughty D, Junkin J, Kurz P, Selekof J, Gray M, Fader M, Bliss DZ, Beeckman D, Logan S. : Incontinence-Associated Dermatitis Consensus Statement, Evidence -Based Guidelines for Prevention and Treatment, and Current Challenges. J Wound Ostomy Continence Nurs 39: , Dasgupta R, Langer JC: Transanal pull-through for Hirschsprung disease. Semin Pediatr Surg 14:64-71, Dasgupta R, Langer JC: Hirschsprung disease. Curr Probl Surg 41: , van de Ven TJ, Sloots CE, Wijnen MH, Rassouli R, van Rooij I, Wijnen RM, de Blaauwl: Transanal endorectal pullthrough for classic segment Hirschsprung s disease: With or without laparoscopic mobilization of the rectosigmoid. J Ped Surg 48: , Hollwarth ME, Rivosecchi M, Schleef J, Deluggi S, Fasching G, Ceriati E, Ciprandi G, DePeppo F: The role of transanal endorectal pull-through in the treatment of Hirschsprung s disease- A multicenter experience. Pediatr Surg Int
9 18: , Georgeson KE, Robertson DJ: Laparoscopicassisted approaches for the definitive surgery for Hirschsprung s disease. Semin Pediatr Surg 4: , Craigie RJ, Conway SJ, Cooper L, Turnock RR, Lamont GS, Baillie CT, Kenny SE: Primary pull-through for Hirschsprung s disease: Comparison of open and laparoscopic-assisted procedures. J Laparoendosc Adv Surg Tech A 17: , Hassan HS, Hashish AA, Fayad H, Elian A, Elatar A, Afify M, Elhalaby EA: Redo Surgery for Hirschsprung s disease. Ann Ped Surg 4:42-50, Nasr A, Langer JC: Evolution of the technique in the transanal pull-through for Hirschsprung's disease: effect on outcome. J Pediatr Surg 42:36-39, Tang ST, Wang GB, MD, Cao GQ, Wang Y, Mao YZ, Li SW, Li S, Yang Y, Yang J, Yang I: 10 years of experience with laparoscopic-assisted endorectal Soave pull-through procedure for Hirschsprung s disease in China. J Laparoendosc Adv Surg Tech A 22: , 2012
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