Primary laparoscopic endorectal pull-through procedure with or without a postoperative rectal tube for hirschsprung disease: a multicenter perspective study.
J Pediatr Surg
; 55(3): 381-386, 2020 Mar.
Article
em En
| MEDLINE
| ID: mdl-31296328
ABSTRACT
BACKGROUND:
Hirschsprung-associated enterocolitis (HAEC) is a significant complication of HD both in the pre- and postoperative periods. This was a large multicenter series study to determine the effect of preserving a postoperative rectal tube on preventing HAEC after primary laparoscopic endorectal pull-through procedure.METHODS:
Between 2014 and 2017, a total of 383 consecutive patients with rectosigmoid segment HD were randomly divided into group A (nâ¯=â¯190) and group B (nâ¯=â¯193). All of them underwent primary laparoscopic pull-through procedure, with the same postoperative treatment protocols except for group A with a rectal tube after surgery for 5â¯days, while group B did not have it. The mean time of follow-up was 2.0⯱â¯0.53â¯years (0.5-3.6â¯years). Demographics, operative data, postoperative complications, and clinical outcomes were compared between these two groups.RESULTS:
Outcomes within 1â¯month after surgery indicated a lower incidence of abdominal distention (4% vs 15.5%, Pâ¯<â¯0.05) and postoperative HAEC (1.2% vs 6.8%, Pâ¯<â¯0.05) in group A compared to group B. Beyond 1â¯month after surgery, the overall incidence of HAEC was not significantly different (12% vs 13.1%, Pâ¯=â¯0.54). However, further analysis revealed that the patients who suffered HAEC twice or above twice in group A were significantly less than those in group B (3.6% vs 8.3%, pâ¯=â¯0.02). There were no significant differences in the defecation frequency and other complications.CONCLUSIONS:
Primary laparoscopic endorectal pull-through procedure with a postoperative rectal tube can reduce the early-stage postoperative incidence of abdominal distension and HAEC and the risk of HAEC recurrence in the long term, and is beneficial to postoperative management. LEVEL OF EVIDENCE Level 2.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Reto
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Procedimentos Cirúrgicos do Sistema Digestório
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Laparoscopia
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Enterocolite
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Doença de Hirschsprung
Tipo de estudo:
Clinical_trials
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Etiology_studies
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Guideline
Limite:
Child, preschool
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Female
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Humans
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Infant
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Male
/
Newborn
Idioma:
En
Revista:
J Pediatr Surg
Ano de publicação:
2020
Tipo de documento:
Article
País de afiliação:
China