Comparison of embryonic nature orifice transumbilical endoscopic surgery with conventional laparoscopic surgery treatmenting Hirschsprung disease / 中华实用儿科临床杂志

Objective To compare the therapeutic effects of embryonic nature orifice transumbilical endoscopic surgery(ENOTES) with conventional laparoscopic(CL) surgery in Hirschsprung disease(HD).Methods A total of 111 children from Sep.2009 to Dec.2010 were included in the retrospective study.The patients were divided into 2groups:ENOTES group (66 cases) and CL group (45 cases).The general conditions of children were reviewed operative situation,postoperative complications and defecation 1 year after operation.Results In the left colectomy,there was no difference between 2 groups in age,weight,operative blood loss and postoperative stay (all P ＞ 0.05),but ENOTES took up less time than CL(P ＜ 0.05) ;in the subtotal colectomy,no significant difference existed in all series.All children underwent primary radical surgery,neither transfer to open surgery nor dead case.In ENOTES group,there were 9 cases suffering from enterocolitis postoperatively (13.6％),while 7 cases (15.6％) in CL group.Twenty-eight patients in ENOTES group and 12 in CL group were followed up for 1 year.Less abdominal distension postoperatively was noted in ENTOES group than CL group(P ＜ 0.05),but no other difference in other available data.In addition,no obvious operative scar was noted on the abdomen in ENOTES group,what meant better cosmetic benefit than CL.Conclusion HD treated with ENOTES can gain the same outcomes with CL with better cosmetic effect.

Transumbilical laparoscopic pull-through for children with hypoganglionosis / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the surgical outcomes after on transumbilical laparoscopic pull-through procedure for pediatric hypoganglionosis(HYP).</p><p><b>METHODS</b>Twelve children with HYP had received transumbilical laparoscopic pull-through procedure from June 2009 to June 2010. Specially designed curved and elongated laparoscopic instruments were used during the procedures. All the patients were followed up over 10 months. Data were collected and analyzed. The diagnosis of hypoganglionsis was pathologically confirmed.</p><p><b>RESULTS</b>No conversions to laparotomy or traditional laparoscopic surgery were required and there were no damages to the abdominal blood vessels, intestine, ductus deferens, or ureters. The average duration of operation was 140 min. The mean intraoperative blood loss was 45 ml. The mean length of specimen was 40 cm. Postoperatively there were no complications such as anastomotic leak, anastomotic stricture, constipation, seepage, or fecal in continence. The average hospital stay after surgery was 9 days. During 10 to 22 months of follow-up(median 16 months), no postoperative recurrence was noticed. No obvious scar was seen 1 months after surgery.</p><p><b>CONCLUSION</b>It is safe and effective for children with hypoganglionosis to undergo transumbilical laparoscopic pull-through procedure.</p>

Reoperation for postoperative constipation recurrences of Hirschsprung disease / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To summarize the causes and treatment experiences of postoperative constipation recurrences of Hirschsprung disease.</p><p><b>METHODS</b>Clinical data of 37 cases receiving operation again for postoperative constipation recurrences of Hirschsprung disease were collected. The recurrent causes, reoperation procedures and therapeutic efficacy were analyzed.</p><p><b>RESULTS</b>Among 37 cases, the recurrent causes included insufficient resection of the intestine in 14 cases, co-existent intestinal neural hypogenesis in 6, gate syndrome in 5, and others in 12 cases. There was no postoperative death. Thirty-one cases (83.8%) were followed-up from 6 months to 11 years. The defecation frequency was 1-2 times per day in 15 cases, one times per two days in 7, one times per three days in 6 cases. Two cases could defecate with the help of laxative purgatives. Nobody had incontinence.</p><p><b>CONCLUSION</b>The main cause of postoperative constipation recurrences of Hirschsprung disease is insufficient resection of the intestine,and reoperation can get better results.</p>