Hirschsprung disease managed with one-stage transanal endorectal pullthrough in a low-resource setting without frozen section
Abstract Background Over the past few decades, surgery for Hirschsprung’s disease (HD) has evolved into a minimally invasive, single-stage procedure with excellent outcomes. Intraoperative frozen section biopsy is critical for this procedure to avoid the potential risk of leaving a retained aganglio...
| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
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BMC
2022-03-01
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| Series: | BMC Surgery |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12893-022-01536-9 |
| _version_ | 1819294647431725056 |
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| author | Samuel Negash Hanna Getachew Dagnachew Tamirat Tihitena Negussie Mammo |
| author_facet | Samuel Negash Hanna Getachew Dagnachew Tamirat Tihitena Negussie Mammo |
| author_sort | Samuel Negash |
| collection | DOAJ |
| description | Abstract Background Over the past few decades, surgery for Hirschsprung’s disease (HD) has evolved into a minimally invasive, single-stage procedure with excellent outcomes. Intraoperative frozen section biopsy is critical for this procedure to avoid the potential risk of leaving a retained aganglionic segment. However, this facility is not available in most low-income countries. Therefore, a two-stage procedure with an initial colostomy is still practiced in the developing world. We aimed to evaluate the outcome of single-stage transanal pullthrough performed in a facility without frozen section biopsy. Methods A retrospective review of all patients who underwent transanal pullthrough in two teaching hospitals over a 6-year period (2015–2020). Results Forty-seven children underwent transanal endorectal pullthrough (TERPT). Age at surgery ranged from 2 months to 6 years and mean weight was 8.7 kg. Barium enema did not show transition zone in 6 patients (12.8%) while others demonstrated short segment HD. Intraoperatively, the transition zone was visualized in 40 patients (85%). TERPT alone was performed in 35 (74.5%), TERPT with laparotomy to visualize transition zone in 9 (26.7%) and TERPT with transabdominal mobilization was required in 3 (6.4%). Definitive histopathologic examination revealed aganglionic segment pullthrough in 4 (8.5%) and transitional zone pullthrough in another 4 (8.5%). However, with long term follow up all eight children remained asymptomatic and no intervention was required. Conclusions Transanal pullthrough offers reduced number of surgeries and faster recovery. We have also observed a good functional outcome despite a discrepancy with pathology results. Overall, our data suggests it is a safe and viable option for the treatment of short segment HD in facilities where frozen section is not available. |
| first_indexed | 2024-12-24T04:29:39Z |
| format | Article |
| id | doaj.art-5fc8451969da426b85a4eeb28b02e06f |
| institution | Directory Open Access Journal |
| issn | 1471-2482 |
| language | English |
| last_indexed | 2024-12-24T04:29:39Z |
| publishDate | 2022-03-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Surgery |
| spelling | doaj.art-5fc8451969da426b85a4eeb28b02e06f2022-12-21T17:15:26ZengBMCBMC Surgery1471-24822022-03-012211510.1186/s12893-022-01536-9Hirschsprung disease managed with one-stage transanal endorectal pullthrough in a low-resource setting without frozen sectionSamuel Negash0Hanna Getachew1Dagnachew Tamirat2Tihitena Negussie Mammo3Unit of Pediatric Surgery, Addis Ababa UniversityUnit of Pediatric Surgery, Addis Ababa UniversityDepartment of Pathology, Addis Ababa UniversityUnit of Pediatric Surgery, Addis Ababa UniversityAbstract Background Over the past few decades, surgery for Hirschsprung’s disease (HD) has evolved into a minimally invasive, single-stage procedure with excellent outcomes. Intraoperative frozen section biopsy is critical for this procedure to avoid the potential risk of leaving a retained aganglionic segment. However, this facility is not available in most low-income countries. Therefore, a two-stage procedure with an initial colostomy is still practiced in the developing world. We aimed to evaluate the outcome of single-stage transanal pullthrough performed in a facility without frozen section biopsy. Methods A retrospective review of all patients who underwent transanal pullthrough in two teaching hospitals over a 6-year period (2015–2020). Results Forty-seven children underwent transanal endorectal pullthrough (TERPT). Age at surgery ranged from 2 months to 6 years and mean weight was 8.7 kg. Barium enema did not show transition zone in 6 patients (12.8%) while others demonstrated short segment HD. Intraoperatively, the transition zone was visualized in 40 patients (85%). TERPT alone was performed in 35 (74.5%), TERPT with laparotomy to visualize transition zone in 9 (26.7%) and TERPT with transabdominal mobilization was required in 3 (6.4%). Definitive histopathologic examination revealed aganglionic segment pullthrough in 4 (8.5%) and transitional zone pullthrough in another 4 (8.5%). However, with long term follow up all eight children remained asymptomatic and no intervention was required. Conclusions Transanal pullthrough offers reduced number of surgeries and faster recovery. We have also observed a good functional outcome despite a discrepancy with pathology results. Overall, our data suggests it is a safe and viable option for the treatment of short segment HD in facilities where frozen section is not available.https://doi.org/10.1186/s12893-022-01536-9Transanal endorectal pullthroughFrozen sectionHirschsprung’s diseaseEthiopia |
| spellingShingle | Samuel Negash Hanna Getachew Dagnachew Tamirat Tihitena Negussie Mammo Hirschsprung disease managed with one-stage transanal endorectal pullthrough in a low-resource setting without frozen section BMC Surgery Transanal endorectal pullthrough Frozen section Hirschsprung’s disease Ethiopia |
| title | Hirschsprung disease managed with one-stage transanal endorectal pullthrough in a low-resource setting without frozen section |
| title_full | Hirschsprung disease managed with one-stage transanal endorectal pullthrough in a low-resource setting without frozen section |
| title_fullStr | Hirschsprung disease managed with one-stage transanal endorectal pullthrough in a low-resource setting without frozen section |
| title_full_unstemmed | Hirschsprung disease managed with one-stage transanal endorectal pullthrough in a low-resource setting without frozen section |
| title_short | Hirschsprung disease managed with one-stage transanal endorectal pullthrough in a low-resource setting without frozen section |
| title_sort | hirschsprung disease managed with one stage transanal endorectal pullthrough in a low resource setting without frozen section |
| topic | Transanal endorectal pullthrough Frozen section Hirschsprung’s disease Ethiopia |
| url | https://doi.org/10.1186/s12893-022-01536-9 |
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