A Comparative Study Of Laparoscopically Assisted Transanal Soave's And Swenson's Procedure For Common Hirschsprung's Disease

Purpose: To compare the therapeutic effects of laparoscopically assisted transanal Soave's with Swenson's procedure for common HD,and to put forward reasonable suggestions for clinical treatment options.Methods: The clinical data of 60 children who received HD laparoscopy in our department from 2010 to 2015 were analyzed retrospectively.According to the operation method,they were divided into two groups: 32 cases in Soave's procedure and 28 cases in Sewenson's procedure.According to the typical clinical symptoms and signs,barium enema and colonography,delayed abdominal plain film examination 24 hours later,anorectal manometry and pathological histological examination,all common HD were diagnosed.Two kinds of operation methods with comparability were taken as the research objects,respectively recording sex,age,anorectal manometry data,intraoperative blood loss,operation time,intestinal function recovery time,postoperative hospital stay time;peripheral venous blood was taken to detect Ig G,Ig A,Ig M,C3 and C4 humoral immune indexes before,24 h and 72 h after operation;C-reactive protein(C-reactive protein,CRP)and prealbumin(PA)were used to detect the protein metabolism index;the daily defecation frequency,fecal incontinence and the degree of fecal contamination in 1 month,6 months,1 year and 5 years after the operation were followed up to understand the defecation function;other related complications and the quality of life in 5 years after the operation were followed up;anorectal manometry was performed to understand the recovery of anal control.To evaluate the severity of fecal incontinence and fecal contamination,Li Zheng's anal score standard was used.To evaluate the defecation function,Ritala's score method was used.To evaluate the quality of life of children after anorectal operation,the questionnaire was used.Results: There was no significant difference in gender and age between the two groups;laparoscopic assisted transanal Soave's operation had a longer operation time,more blood output during the operation,more severe fecal incontinence and fecal contamination in the lately postoperative period.Li Zheng's anal score was lower in the first month after the operation,and the anal resting pressure decreased more significantly.There was no significant difference in the recovery time of postoperative intestinal function,postoperative hospital stay,preoperative and postoperative serum immune indexes,daily defecation frequency,long-term defecation function and short-term and long-term complications,and there was no significant difference in Li Zheng's anal score,rintala's score and quality of life score 5 years after operation.Conclusion: Although the short-term comparison effect is not good in Soave's procedure,the abdominal scar is invisible,and there is no significant difference in the long-term comparison.While Sewenson's procedure is more feasible due to intraoperative rapid biopsy in advance,but remains more abdominal scar.The choice of operation for common HD should be personalized individual principle based on the habit of surgeons and the parents' intention-to-treat.