Comparative Analysis Of Laparoscopic-assisted Soave And Traditional Open Surgery In Children Wth Hischsprung’s Disease

Objective: To compare and analyse postoperative morbidity and recovery of laparoscopic-assisted Soave and traditional open surgery for the treatment of Hischsprung’s disease(HD)in children.The surgical techniques and experience,clinical efficacy,and prognosis of laparoscopic-assisted Soave and traditional open surgery are further explained,to guide the clinical treatment of HD.Methods: From January 2013 to December 2018,52 cases of children diagnosed with HD were admitted and treated in our hospital.The laparoscopic-assisted Soave surgery was considered as the endoscopic group,and transanal or abdominal Heart-shape anastomosis was regarded as Open group.In the endoscopic group,there were 25 patients(20 males,5 females),with age ranging from 3 to 9 years.Concerning subtypes of HD,there were 2 short-segment types,20 common types,and 3 long-types.In the open group,there were 27 cases(21males and 6 females),with age ranging from 3 months to 8 years.There were 3cases with short-segment type,19 cases with common types,and 5 cases with long-range types.The results were statistically compared and analyzed,including perioperative indicators(operation time,intraoperative blood loss,postoperative hospital stay,hospitalization cost),approach-related complications(incision infection,intestinal obstruction,anastomotic fistula,enterocolitis,Anal stenosis,constipation,fecal stool),medical complications(lung infection,urinary system infection,abdominal infection,stress ulcer,deep vein thrombosis)and daily defecation counts at follow-up in 1 month,3 months,6 Monthly and 12-month.Results:1.Perioperative Indicators: In the endoscopic group,the operation time was shorter than that of the open group(183.04 ± 25.5min vs 206.04 ± 25.9min),the postoperative hospital stay was shorter than that of the open group(7.80 ± 2.94 d vs 10.25 ± 2.18d),and the intraoperative blood loss was less than that of the open group(12.6 ± 10.11 ml vs 22.00 ± 7.26ml),which indicating that there was no statistical significance between the two groups(P <0.001).But the hospitalization cost of the endoscopic group was greater than the open group(31552.0 ± 1579.7yuan vs 11363.5 ± 175.4 yuan,P <0.001).2.Surgery-related complications: In the endoscopic group,there were 1 case(4.0%)with anastomotic fistula,1 case(4.0%)with feces,and 1 case(4.0%)with constipation.The total complication rate was 12.0%.In open group,2 cases(7.4%)with constipation,2 cases(7.4%)with feces,2 cases(7.4%)with enterocolitis,2cases(7.4%)with anastomotic fistula,1 case(3.7%)with anal stenosis,2 cases(7.4%)with incision infection,1 case(3.7%)with intestinal obstruction.The total complication rate was 44.4%.The surgery-related complication rate in the endoscopic group was lower than in the open group without statistical significance(P <0.05).3.Perioperative iatrogenic complications: In the endoscopic group,there were 2cases(8.0%)with pulmonary infections,2 cases(8.0%)with urinary infections,1Case(4.0%)with abdominal infection.In open group,there were 3 patients(11.1%)with pulmonary infections,2 patients(7.4%)with urinary infections and 1patient(3.7%)with abdominal infection.But the statistical difference between two groups was not observed(P> 0.05).4.The anal function at follow-up in 1 month,3 months,6 months,and 12 months in two groups was recorded.Patients in endoscopic group has fewer times of daily defecation than those in the open group.The difference was statistically significant(P <0.001).The Heikkinen scale showed that the endoscopic group had an excellent anal function outcome than the open group and no statistical significance was found(P <0.05).Conclusion : Laparoscopic-assisted Soave surgery is a safe and effective surgical method for treating HD in children.Compared with traditional open surgery,laparoscopic-assisted Soave surgery can resect the pathological changes of the intestinal tract,has less damage to the rectal sphincter,resulting less postoperative short-term and long-term complications and better early anal function recovery.Also,the operation time is short,the amount of intraoperative bleeding is small and the length of hospital stay is short.Laparoscopic-assisted Soave surgery is worth clinical promotion.