Clinical Research On The Laparoscopic-assisted Modified Soave One-stage Endorectal Pull-through For Hirschsprung’s Disease

Objective:This study was designed to evaluate the clinical effect of laparoscopic-assisted modified soave endorectal pull-through for common type Hirschsprung’s Dis ease(HD), in order to further improve operation means while reducing postoperative complications.Methods:59common types HD patients diagnosed and operated in our department were included into this retrospective study from January of2009to December of2013, they were divided into laparoscopic-assisted modified soave endorectal pull-through(LAEPT) and through transanal modified soave endorectal pull-through(TEPT) groups. Anal operation parts of both groups all used modified soave operation method which dissected mucosa, circular and longitudinal muscles in a stepwise and gradient method.38patients were included into LAEPT group,29males and9female, average age of12.7months. TEPT group had21cases,18males and3females, average age of19.0months. We then compared the preoperative periods (operation time, anal operating time, blood loss, length of removal colon, bowel movements recovery time, length of postoperative hospital stays), rate of early-postoperative complications(perianal dermatitis, urinary retention, enterocolitis), rate of late-postoperative complications(anastomotic stricture, soiling,constipation, enterocolitis). Evaluating postoperative anal function by Wingspread score in3,6,12months after operation, anorectal manometry was used to evaluate the anal resting pressure and rectal anal inhibitory reflex(RAIR) in6,12months after operation. Barium enema was used to measure the anorectal angle and examine the24hours barium residue.Results:The anal operating time (44.8±7.3min vs73.8±10.7min), intraoperative blood loss (15.4±10.5ml vs25.2±17.4ml), the length of removal colon (31.2±4.9cm vs26.4±3.6cm) and the length of hospital stays (8.4±1.4d vs10.4■1.5d) were significantly less in LAEPT than that of TEPT (P<0.05). But the operation time were significantly longer in LAEPT than that of TEPT (P<0.05).There were no significant difference in bowel movement time(P>0.05).15patients occurred the early-postoperative complications in59patients, rate was25.4%. which had statistical differences between LAEPT and TEPT(5cases vs10cases, P<0.05).13patients appeared late-postoperative complications, therewere no significantly between group (6cases vs7cases, P>0.05).59patients ofpostoperative had completed followed-up in6months,42patients finished followed-up in12months, in which LAEPT21cases, TEPT21cases. Wingspread score results: thepostoperative excellent rate of anal function were52.4%,71.4%,90.5%in3,6,12months,there were statistical differences（P<0.05）,but with no significant difference betweengroups（P>0.05）. Anorectal manometry results: the postoperative anal resting pressure wassignificantly lower in6month than preoperative periods (P<0.05), which weresignificantly lower in LAEPT than TEPT in12mont（h5.7±1.6kpa vs4.3±0.9kpa, P<0.05）.Postoperative RAIR of all patients had not recovered in6month, LAEPT group has12cases recovered in12months, TEPT has recovered10cases, there were no statisticaldifferences. Postoperative barium enema results: the anorectal angle significantly increasedat6month postoperatively than preoperative period in both group（sP<0.05）, there were nosignificantly difference in6month and12month within groups (P>0.05), but which wassignificantly reduced in LAEPT than TEPT group（97.3±7.60vs107.4±8.20, P<0.05）. The24hours barium residue was significantly less in LAEPT than that of TEPT in6monthpostoperatively (8cases vs10cases, P<0.05）, but postoperative12month results had nosignificantly difference in both groups(LAEPT4cases vs TEPT5cases, P>0.05).Conclusion：Compared with TEPT for common type HD, LAEPT for common type HDhas the advantages of less bleeding, shorter anal operating time and less postoperativehospital stays, which can reduce the drag related damages of anal sphincter, decrease theincidence of early-postoperative complications. Besides LAEPT can reduce anastomotictension for solute colon ascendens and splenic flexure of colon. LAEPT is better than TEPT formaintaining the faeces storage shapes of normal colon and anorectal angle.