Assessment of Patients with Hirschsprung Disease and the Use of Laparoscopy

Özet

Objectives: This study aims to evaluate patients who were diagnosed and treated due to Hirschsprung disease (HD) in our clinic.Methods: We retrospectively evaluated the demographic and clinical findings of the patients with HD, who were operated in ourclinic between January 2010 and December 2015.Results: During study period, 28 patients (19 male 9 female) were found to be operated due to HD in our clinic. Mean age was 16.8months (1-168). “Transanal Endorectal Pull–through (TERPT)” was performed to 20 of them, Duhamell procedure to five and Soaveprocedure to three of them. TERPT was applied as laparoscopy assisted in four of them and biopsies were taken laparoscopicallypreoperatively from one of the patients from each group. Soave procedure was performed in three patients; one had anal stenosisand history of recurrent enterocolitis after TERPT procedure and pathologic analysis revealed neuronal intestinal dysplasia andthe other one had total colonic HD and performed Soave procedure with colonic patch. Seven (25%) patients had enterocolitis.Frequencies of enterocolitis were three in two patients, two in two patients and one in three patients. Broad spectrum anibioticsand rectal washouts were supplied to these patients. Five of the seven patients with enterocolitis were operated with TERPT; twopatients were operated with Duhamell procedure. Only one of them had total colonic HD. Three patients had total colonic HDdiagnosis. Two of them were operated with Duhamell-Martin procedure and one was with Soave procedure with colonic patchaccording to Kimura technique. Anal stenosis developed in two patients after TERPT and treated with dilatations. Soiling rate was3% (1/28) and this single patient was treated with laxatives and toilet training. Mean duration of hospitalization was 8.75 (2-14)days. Mean length of the removed intestinal segment was 23.6 (5-38) cm. Mean follow-up was for 35.5 (2-56) months. Neither ofthe patients was followed in the intensive care unit postoperatively nor died.Conclusion: TERPT procedure win priority in HD, but other procedures keep importance. Recently, laparoscopy-assisted TERPT ispreferred in our clinic in HD therapy due to easy biopsy, full exposure to the transitional zone, the advantage of meso preparationof colon and prevention of strained anastomosis.