Published online Dec 14, 2019. doi: 10.3748/wjg.v25.i46.6781
Peer-review started: October 1, 2019
First decision: November 4, 2019
Revised: November 11, 2019
Accepted: November 29, 2019
Article in press: November 29, 2019
Published online: December 14, 2019
Processing time: 74 Days and 9.5 Hours
Since 1998, one-stage transanal endorectal pull-through for the treatment of rectosigmoid Hirschsprung's disease (HD) has been widely used in newborns without complications. Recently, the one-stage laparoscopic procedure has been considered a favorable option for the management of patients with HD due to its superior cosmetic results. However, enterostomy is required in some HD cases for enterocolitis and dilated colon. Our transumbilical enterostomy (TUE) and two-stage laparoscopy-assisted anorectoplasty were effective and achieved a similar cosmetic effect to the one-stage laparoscopy on the abdominal wall in patients with anorectal malformations, but the effect in patients with HD is unclear.
Our TUE and two-stage laparoscopy-assisted anorectoplasty were effective and achieved a similar cosmetic effect to the one-stage laparoscopy on the abdominal wall in anorectal malformations, but the effect in patients with HD is unclear.
This study aimed to evaluate the safety, efficacy and cosmetic results of TUE for the management of HD in a two-stage laparoscopy-assisted pull-through, and was retrospectively compared with conventional abdominal enterostomy (CAE).
From June 2013 to June 2018, 53 patients (40 boys, 13 girls; mean age at enterostomy: 5.5 ± 2.2 mo) who underwent enterostomy and two-stage laparoscopy-assisted pull-through for HD with stoma closure were reviewed at our institution. Two enterostomy approaches were used: TUE in 24 patients and CAE in 29 patients. Eleven patients with rectosigmoid HD had severe preoperative enterocolitis or a dilated colon. 26 patients had long-segment HD, and 16 patients had total colonic aganglionosis (TCA). Patients with left-sided HD underwent the two-stage laparoscopic Soave procedure, and patients with right-sided HD and TCA underwent the laparoscopic Duhamel procedure. Demographics, operation duration, complications and cosmetic results were respectively evaluated.
There were no differences between the groups with respect to gender, age at enterostomy, weight and clinical type (P > 0.05). No conversion to open technique was required. Two patients experienced stomal mucosal prolapse in the TUE group and 1 patient in the CAE group (8.33% vs 3.45%, P > 0.05). No parastomal hernia was observed in the two groups. Wound infection at the stoma was seen in 1 case in the TUE group, and 2 cases in the CAE group (4.17% vs 6.90%, P > 0.05). No obstruction was found in any of the patients in the TUE group, whereas obstruction was found in 1 patient in the CAE group. Enterocolitis was observed in 3 and 5 patients in the TUE and CAE group, respectively (12.50% vs 17.24%, P > 0.05). There was no significant difference between TUE group and CAE group in the incidence of soiling and constipation (P > 0.05). The cosmetic result in terms of the scar score in the TUE group was better than that in the CAE group (6.83 ± 0.96 vs 13.32 ± 1.57, P < 0.05).
TUE is a safe and feasible method for the treatment of HD, and the staged enterostomy and two-stage laparoscopy-assisted pull-through procedure achieved a similar cosmetic effect to the one-stage laparoscopic procedure.
TUE could help patients who require enterostomy to achieve good cosmetic results in the treatment of HD using the two-stage laparoscopy-assisted pull-through with stoma closure, which is expected to be favored by patients and their families in the future.