| Background and PurposeHirschsprung’s disease(HSCR)is a common congenital digestive system malformation in children,characterized by developmental disorders of the enteric nervous system(ENS),including defects and disorders in the migration,proliferation,and differentiation of neural crest cells(NCC)during embryonic development,resulting in functional obstruction.HSCR can be classified into four types based on the extent,severity,and damage to the enteric nervous system: total colonic,total intestinal,long-segment,and short-segment.In recent decades,with the emergence of new technologies,surgical treatment for HSCR has been continuously improved.Currently,there are two main surgical treatment options for short-segment Hirschsprung’s disease: transanal endorectal pull-through surgery and laparoscopic-assisted pull-through surgery.However,there is limited literature comparing the advantages and disadvantages of these two surgical approaches,especially in terms of short-term and long-term complications,as well as long-term quality of life after surgery.Therefore,the main objective of this study is to compare the efficacy of laparoscopic-assisted transabdominal transanal pull-through surgery and transanal pull-through surgery for short-segment Hirschsprung’s disease,with a particular focus on postoperative bowel function status,and to compare other clinical indicators such as general patient information,intraoperative conditions,early and late postoperative complications,and unplanned secondary surgeries.The aim is to determine the superiority of laparoscopic-assisted pull-through surgery or transanal pull-through surgery.Methods1.According to the inclusion and exclusion criteria,188 cases of short-segment Hirschsprung’s disease(HSCR)patients who underwent surgical treatment at Guangzhou Women and Children’s Medical Center from January 2018 to February2022 were selected.They were divided into two groups based on the use of laparoscopy during the surgery,namely the transanal group(109 cases)which underwent transanal total colonic aganglionosis surgery,and the laparoscopy group(79 cases)which underwent laparoscopy-assisted total colonic aganglionosis resection.2.In this study,general data of the patients,including age,weight,and length of hospital stay,will be collected and recorded from the hospital’s electronic medical record system.Intraoperative variables such as surgical time and intraoperative blood loss will also be documented.Data analysis in this study will be conducted using SPSS 26.0 statistical software.Descriptive statistics such as median and interquartile range will be used for general data,while continuous data such as Krickenbeck score will be expressed as mean ± standard deviation(SD)if normally distributed,and the t-test will be used for between-group comparisons.Qualitative data such as the occurrence of complications will be presented as percentages(%),and the chi-squared test will be used for between-group comparisons.A p-value of < 0.05 will be considered statistically significant for all analyses.3.Data analysis in this study will be conducted using SPSS 26.0 statistical software.Descriptive statistics such as median and interquartile range will be used for general data,while continuous data such as Krickenbeck score will be expressed as mean ± standard deviation(SD)if normally distributed,and the t-test will be used for between-group comparisons.Qualitative data such as the occurrence of complications will be presented as percentages(%),and the chi-squared test will be used for between-group comparisons.A p-value of < 0.05 will be considered statistically significant for all analyses.Results:1.Clinical characteristics: A total of 188 cases were included in the study.There were 109 cases in the transanal group,including 93 male patients and 16 female patients.The median age at the time of surgery was 7 months(2 months to 10 years),with an average weight of 9.83±4.78 kg.There were 79 cases in the laparoscopic group,including 61 male patients and 18 female patients.The median age at the time of surgery was 7 months(2 months to 11 years),with a median weight of 8.98±3.80 kg.There were no significant differences in age,gender,or weight between the two groups of patients.2.Perioperative indicators were recorded.In the transanal group,the mean operative time was 97.46 ± 32.05 minutes,intraoperative blood loss was 6.35 ± 10.64 m L,time to initiate oral intake postoperatively was 1.68 ± 0.68 days,3 cases required unplanned reoperation,and the average length of hospital stay was 12.94 ± 4.51 days with a postoperative hospital stay of 7.75 ± 2.53 days.In the laparoscopy group,the mean operative time was 187.06 ± 60.37 minutes,intraoperative blood loss was 4.24± 2.94 m L,time to initiate oral intake postoperatively was 1.51 ± 0.64 days,the average length of hospital stay was 11.66 ± 3.78 days with a postoperative hospital stay of 7.09 ± 1.81 days.When comparing the two groups,the laparoscopy group had longer operative time(p < 0.01),shorter length of hospital stay(p = 0.04)and postoperative hospital stay(p = 0.049),with no significant differences in intraoperative blood loss and time to initiate oral intake postoperatively.3.Complications: In the transanal group,there were a total of 25 cases of complications(22.9%)after surgery,including 3 cases of early postoperative complications of small bowel colitis,13 cases of late postoperative complications of fecal soiling,3 cases of constipation,1 case of anastomotic stricture,and 2 cases of perianal dermatitis.In the laparoscopic group,there were a total of 8 cases of complications(10.1%)after surgery,including 2 cases of early postoperative complications of small bowel colitis,3 cases of late postoperative complications of fecal soiling,1 case of constipation,1 case of small bowel colitis,and 1 case of perianal dermatitis.The incidence of complications was significantly lower in the laparoscopic group compared to the transanal group.4.Postoperative Follow-up Results: A total of 66 cases in the transanal group completed the follow-up.The Krickenbeck score and bowel frequency at 6 months after surgery were 7.61±0.78 and 4.69±1.36 times/day,respectively,and at 1 year after surgery were 8.11±0.74 and 2.01±0.55 times/day,respectively.In the laparoscopic group,60 cases were followed up.The Krickenbeck score and bowel frequency at 6months after surgery were 7.91±0.75 and 4.59±1.33 times/day,respectively,and at 1year after surgery were 8.43±0.73 and 1.41±0.51 times/day,respectively.There was no statistically significant difference in Krickenbeck score(p=0.15)and bowel frequency(p=0.97)between the two groups at 6 months after surgery.However,at 1year after surgery,the Krickenbeck score and bowel frequency were better in both groups(p=0.02)and(p<0.01),respectively.Conclusions:1.In the treatment of short-segment Hirschsprung’s disease,laparoscopic-assisted total colonic aganglionosis surgery may have a relatively longer operative time,but shorter hospital stay and postoperative hospital stay.2.The incidence of postoperative feces is lower in laparoscopic-assisted total colonic aganglionosis surgery.3.The anal defecation function of the endoscopic group was better than that of the transanal group one year after surgery. |
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