Outcome of primary endorectal pull-through for the treatment of classic Hirschsprung disease.
BACKGROUND
Endorectal pull-through (ERPT) is a widely accepted procedure for the treatment of Hirschsprung's disease (HSCR). This study was aimed at presenting the long-term results of patients with classic HSCR who were operated on with a laparoscopic-assisted Georgeson procedure and to compare them to patients treated with a Soave-Boley procedure.


METHODS
Patients treated for Hirschsprung disease in the period 1997-2006 with a minimum follow-up of 6 months were prospectively included in this study. Demographic details, associated anomalies, surgical technique, length of aganglionosis, and postoperative complications were collected. A questionnaire was submitted to all families to assess general health, bowel adaptation, fecal and urinary continence, cosmetic results, and patients' and parents' perspective of overall outcome.


RESULTS
Overall, 162 patients underwent a pull-through procedure: 25 patients treated with Georgeson and 21 with Soave-Boley ERPT were eligible for this study. Conversion was required in 3 of 28 patients approached laparoscopically. Hospitalization was shorter for patients treated laparoscopically (P < 0.05), whereas length of surgery was comparable. Complication rate was similar for both groups, as well as growth that remained within normal ranges for age. Long-term outcome, in terms of bowel movements, was similar. None of the patients experienced fecal and/or urinary incontinence. Cosmetic results proved to be excellent to good in all patients undergoing the Georgeson and in 67% of patients undergoing the Soave-Boley procedure (P < 0.05). Patients' perspective of overall outcome was excellent in more than 90% of patients from both groups.


CONCLUSIONS
Overall results proved to be similar. Likewise, long-term bowel function did not show significant differences. Nonetheless, if we consider hospitalization and cosmetic results, it becomes clear that the minimally invasive approach should be preferred, when possible, to improve patients' comfort, perspective of overall health status, and psychologic acceptance.
Mattioli
Girolamo
G
Department of Pediatric Surgery, Scientific Directorate, Giannina Gaslini Research Institute, University of Genova, Genova, Italy. girolamomattioli@ospedale-gaslini.ge.it
Pini Prato
Alessio
A
Giunta
Camilla
C
Avanzini
Stefano
S
Della Rocca
Mirta
M
Montobbio
Giovanni
G
Parodi
Stefano
S
Rapuzzi
Giovanni
G
Georgeson
Keith
K
Jasonni
Vincenzo
V
D002648:Child; D002675:Child, Preschool; D013505:Digestive System Surgical Procedures / Q000379:methods*; D005260:Female; D006627:Hirschsprung Disease / Q000601:surgery*; D006801:Humans; D007223:Infant; D010535:Laparoscopy; D008297:Male; D011183:Postoperative Complications; D011446:Prospective Studies; D012007:Rectum / Q000601:surgery*; D018709:Statistics, Nonparametric; D011795:Surveys and Questionnaires; D016896:Treatment Outcome