| Autor: |
LIMA, MARIO, RUGGERI, GIOVANNI, GARGANO, TOMMASO, S. Tursini, L. De Biagi, G. Cobellis, L. Mastroianni, G. Amici, A. Martino, °.M. G. R. Aceti, G. Riccipetitoni, G. Mattioli, V. Jasonni Jasonni Department |
| Přispěvatelé: |
M. Lima, G. Ruggeri, S. Tursini, L. De Biagi, T. Gargano, G. Cobelli, L. Mastroianni, G. Amici, A. Martino, °M.G.R. Aceti, G. Riccipetitoni, G. Mattioli, V. Jasonni Jasonni Department |
| Jazyk: |
italština |
| Rok vydání: |
2005 |
| Předmět: |
|
| Popis: |
Introduction Advances in laparoscopy determinates very important modifications in the treatment of Hirschsprung disease. The aim of this study is analyse the results, of four different centres, in the treatment of Hirschsprung disease, according to Georgeson’s primary laparoscopic pull-through. Materials and Methods In the last 4 years 74 cases of HD, in four different centres of pediatric surgery, were submitted to primary laparoscopic pull-through (LPT) according to Georgeson’s technique. The age ranged between 20 days and 15 years. All were investigated by rectal suction biopsy, barium enema and anorectal manometry. No diverting colostomy was performed and the patients were managed with pre-operative bowel nursing. Surgery required 3 operative ports as described by Georgeson. The colon was examined and several biopsies were performed at different proximal levels to precisely define the normoganglionic colon. Surgery was postponed after the results of the intraoperative histochemical studies. The definitive diagnosis were: 27 ultra short segment (US), 37 recto sigmoid segment (RS), 6 long segment (LS), 1 total colonic aganglia (CA) and 3 rectosigmoid segment associated to IND extended to the left flexure. The mesocolon was divided using ligasure, bipolar or monopolar hook. After the transanal dissection was completed, the videoassisted pull-through was carried out making attention to the placement of the pedicle and of the sieromuscular cuff. The operative time ranged from 180’ and 540’. Results There were 2 conversions to open technique, while in 1 case a postoperative colostomy;no addictional intraoperative complication was found. The patients had analgesics for 24 hours. Bowel movements were observed at 24- 48 hours, the oral feeding started after 48 hours, the median hospital stay was 7 days. At follow-up 3 patients had grade I enterocolitis in the fìrst months; 2 cases of LS and one case of RS had about 4 toilets/day. In one case of US soiling was present for 5 months postoperatively. Conclusion The laparoscopic pulll-through is a safe operation for almost ali cases of HD. It allow to obtain several biopsies necessary to define the precise diagnosis of the disease and to perform a correct surgery. Moreover the laparoscopy permits to avoid the torsion of the vascular pedicle during the trans anal pull-through. |
| Databáze: |
OpenAIRE |
| Externí odkaz: |
|
