title: [Timing investigation of single-stage definitive surgery for newborn with Hirschsprung's disease].
abstract: OBJECTIVE
  To investigate the operation timing of newborns with rectosigmoid Hirschsprung's disease (HD).
  
  
  METHODS
  From March 2013 to September 2015, 35 newborns diagnosed as rectosigmoid HD in our department were prospectively and randomly divided into 2 groups: less than 3 months treatment group (18 cases) and more than 3 months treatment group (17 cases, conservative treatment for 3 months). They all underwent laparoscopic-assisted transanal endorectal pull-through (LATEP) (modified Soave) procedure. Clinical data, perioperative conditions, postoperative complication, postoperative anal function evaluated by Wingspread score and barium enema were compared between two groups.
  
  
  RESULTS
  The baseline data of two groups were comparable (all P>0.05). All the cases completed single-stage LATEP procedure successfully without conversion to open operation. Compared with more than 3 months treatment group, preoperative bowel preparation time and operation time were significantly shorter [(6.2±3.3) vs. (9.3±4.1) days, P=0.042; (95±15) vs.(121±23) minutes, P=0.029, respectively], intra-operative blood loss was significantly less [(13±3) ml vs. (22±5) ml, P=0.036], length of resected bowel was significantly shorter [(16±5) cm vs.(23±8) cm, P=0.033], and bowel movement recovery time, parenteral nutrition time, hospital stay were also significantly shorter [(2.3±0.5) vs. (2.9±0.6) days, P=0.046; (5.1±2.1) vs. (5.9±2.3) days, P=0.048; (12.9±3.3) vs. (15.8±4.3) days, P=0.049, respectively] in less than 3 months treatment group. No short-term complications, such as anastomotic leak, interlayer infection and abdominal infection occurred in both groups. The follow-up period ranged from 2 months to 24 months. Only the incidence of perianal excoriation was significantly higher in less than 3 months treatment group compared with more than 3 months treatment group [50.0%(9/18) vs. 23.5%(4/17), P=0.045]. Wingspread score results at 6 and 12 months after operation showed excellent rate of postoperative anal function, which was not significantly different between two groups[ <3 months group : 81.3%(13/16) and 92.9%(13/14); >3 months group: 85.7%(12/14) and 92.3%(12/13), all P>0.05]. Postoperative barium enema results at 6 and 12 months after operation all showed normal shape of colon without residue of barium.
  
  
  CONCLUSIONS
  For newborns with rectosigmoid HD, single-stage definitive operation performed at the age less than 3 months has the advantages of shorter preoperative preparation time, less operating injury, shorter resected bowel, and faster postoperative recovery as compared to the age more than 3 months. If rectosigmoid HD is definitively diagnosed, early operation is suggested to perform at the age less than 3 months.
authors: Shangjie
authors: S
authors: Xiao
authors: Wenyi
authors: W
authors: Yang
authors: Like
authors: L
authors: Yuan
authors: Ying
authors: Y
authors: Zhang
authors: Tao
authors: T
authors: Song
authors: Lu
authors: L
authors: Xu
authors: Song
authors: S
authors: Tian
authors: Wuping
authors: W
authors: Ge
authors: Jialiang
authors: J
authors: Zhou
authors: Department of Neonatal Surgery, Guangdong Women and Children Hospital, Guangzhou 511400, China. zhuxc@126.com.
authors: Xiaochun
authors: X
authors: Zhu
mesh_terms: D057868:Anastomotic Leak; D000071941:Barium Enema; D016063:Blood Loss, Surgical; D003672:Defecation; D013505:Digestive System Surgical Procedures; D005260:Female; D006627:Hirschsprung Disease / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D059413:Intraabdominal Infections; D010535:Laparoscopy; D007902:Length of Stay; D008297:Male; D061646:Operative Time; D010288:Parenteral Nutrition; D010289:Parenteral Nutrition, Total; D011183:Postoperative Complications; D011184:Postoperative Period; D016896:Treatment Outcome