Duhamel Versus Swenson Pull-Through for Total Colonic Aganglionosis: A Multi-Institutional Study.

Autor: Halaweish I; Department of Surgery, Nationwide Children's Hospital, Columbus, OH, USA. Electronic address: ihab.halaweish@nationwidechildrens.org., Srinivas S; Department of Surgery, Nationwide Children's Hospital, Columbus, OH, USA., Farooqui Z; Department of Surgery, Cincinnati Children's Hospital, Cincinnati, OH, USA., Sutthatarn P; Department of Surgery, Hospital for Sick Children and University of Toronto, Toronto, Canada., Campbell D; Department of Surgery, Nationwide Children's Hospital, Columbus, OH, USA; College of Medicine, The Ohio State University, Columbus, OH, USA., Frischer J; Department of Surgery, Cincinnati Children's Hospital, Cincinnati, OH, USA., Wood RJ; Department of Surgery, Nationwide Children's Hospital, Columbus, OH, USA., Langer JC; Department of Surgery, Hospital for Sick Children and University of Toronto, Toronto, Canada.
Jazyk: angličtina
Zdroj: Journal of pediatric surgery [J Pediatr Surg] 2024 Feb; Vol. 59 (2), pp. 216-219. Date of Electronic Publication: 2023 Oct 18.
DOI: 10.1016/j.jpedsurg.2023.10.017
Abstrakt: Background: Total colonic aganglionosis (TCA) is a rare variant of Hirschsprung disease (HD) where the colon and portion of distal ileum lack ganglion cells. Most pediatric use either a straight ileoanal (Swenson or Yancey-Soave) or a short Duhamel pull-through for TCA. There are no large studies comparing these techniques. We aimed to compare short-and medium-term outcomes between these approaches.
Method: A retrospective review was performed among children with TCA from 2001 to 2019 undergoing a primary Duhamel or Swenson pull-through across three large children's hospitals. Patients undergoing redo and patients with greater than 30 % small bowel aganglionosis were excluded. We gathered data on demographics, operative approach, and outcomes at one, two, and three years. Continuous variables were analyzed with t-tests and categorical variables with Chi square or Fisher's tests.
Results: There were 54 patients, with 26 (48 %) undergoing Duhamel and 28 (52 %) undergoing Swenson pull-through. There were no differences in sex, age, medical comorbidities, or operative details, including age at pull-through, laparoscopic vs open, length of involved small bowel, and operative time. Length of stay and post-operative complications were not different. Three years after pull-through, patients undergoing Duhamel had fewer stools per day (1-3 stools 69.6 % vs 14.3 %, p = 0.003) and were less likely to be prescribed fiber supplementation (4.2 % vs 43.8 %, p = 0.003). There were no differences in irrigations, botulinum toxin administration, loperamide, or HD admissions.
Conclusion: Both Duhamel and straight pull-throughs are safe for treatment of TCA, with acceptable short- and medium-term outcomes. Further studies on patient-reported outcomes are necessary to examine long-term differences.
Level of Evidence: III.
(Copyright © 2023 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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