Yi-Ting Yeh1, Hsin-Lin Tsai1, Cheng-Yen Chen2, Jen-Bin Wang3, Tai-Wai Chin1, Chou-Fu Wei4, Chin-Su Liu5. 1. Division of Pediatric Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC. 2. Division of Transplant Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC. 3. Department of Surgery, Taipei Veterans General Hospital Taoyuan Branch, Taoyuan, Taiwan, ROC. 4. Division of Pediatric Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Surgery, Taipei Medical University Hospital, Taipei, Taiwan, ROC. 5. Division of Pediatric Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Division of Transplant Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC. Electronic address: csliu@vghtpe.gov.tw.
Abstract
BACKGROUND: There is a lack of consensus regarding the treatment of total colonic aganglionosis (TCA) with respect to perioperative morbidity, mortality, complications, and functional outcomes. The aim of this study was to review the results of surgical TCA treatment over a 26-year period and characterize the outcomes. METHODS: We retrospectively reviewed the clinical characteristics, surgical courses, and outcomes of TCA patients who underwent definitive pull-through operations from 1986 to 2012. Follow-up data were collected by chart reviews and telephone interviews using a standardized questionnaire. RESULTS: We identified nine infants with TCA (8.6%) from among 105 infants with Hirschsprung's disease treated during the 26-year period. Neither sex predominated (male/female ratio = 4:5). All infants underwent laparotomies and simultaneous enterostomies. All patients eventually underwent modified Duhamel pull-through procedures at a mean age of 179 days (range, 47-352 days). Two infants died of complications after surgery including heart failure and sepsis. The remaining infants recovered smoothly with antilaxative medications, and all but one was weaned off these medications. Although the surviving patients did not catch up on growth, they and their families were satisfied with the surgical results. CONCLUSION: Infants with TCA had satisfactory outcomes after the modified Duhamel pull-through operation. Based on our experience, we suggest that the pull-through operation could be performed earlier, even when there are loose stools from the enterostomy.
BACKGROUND: There is a lack of consensus regarding the treatment of total colonic aganglionosis (TCA) with respect to perioperative morbidity, mortality, complications, and functional outcomes. The aim of this study was to review the results of surgical TCA treatment over a 26-year period and characterize the outcomes. METHODS: We retrospectively reviewed the clinical characteristics, surgical courses, and outcomes of TCA patients who underwent definitive pull-through operations from 1986 to 2012. Follow-up data were collected by chart reviews and telephone interviews using a standardized questionnaire. RESULTS: We identified nine infants with TCA (8.6%) from among 105 infants with Hirschsprung's disease treated during the 26-year period. Neither sex predominated (male/female ratio = 4:5). All infants underwent laparotomies and simultaneous enterostomies. All patients eventually underwent modified Duhamel pull-through procedures at a mean age of 179 days (range, 47-352 days). Two infants died of complications after surgery including heart failure and sepsis. The remaining infants recovered smoothly with antilaxative medications, and all but one was weaned off these medications. Although the surviving patients did not catch up on growth, they and their families were satisfied with the surgical results. CONCLUSION:Infants with TCA had satisfactory outcomes after the modified Duhamel pull-through operation. Based on our experience, we suggest that the pull-through operation could be performed earlier, even when there are loose stools from the enterostomy.
Authors: Fereshteh Salimi Jazi; Tiffany J Sinclair; Chad M Thorson; Ricardo Castillo; Andrew C Bonham; Carlos O Esquivel; Matias Bruzoni Journal: Pediatr Surg Int Date: 2017-11-23 Impact factor: 1.827
Authors: Fereshteh Salimi Jazi; Julia M Chandler; Chad M Thorson; Tiffany J Sinclair; Florette K Hazard; John A Kerner; Sanjeev Dutta; James C Y Dunn; Stephanie D Chao Journal: BMC Pediatr Date: 2019-04-05 Impact factor: 2.125