Retrospective Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Dec 14, 2019; 25(46): 6781-6789
Published online Dec 14, 2019. doi: 10.3748/wjg.v25.i46.6781
Transumbilical enterostomy for Hirschsprung's disease with a two-stage laparoscopy-assisted pull-through procedure
Pei-Pei Xu, Xiao-Pan Chang, Xi Zhang, Shui-Qing Chi, Guo-Qing Cao, Shuai Li, De-Hua Yang, Xiang-Yang Li, Shao-Tao Tang
Pei-Pei Xu, Xiao-Pan Chang, Xi Zhang, Shui-Qing Chi, Guo-Qing Cao, Shuai Li, De-Hua Yang, Xiang-Yang Li, Shao-Tao Tang, Department of Pediatric Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, Hubei Province, China
Author contributions: Xu PP collected and analyzed the data, and drafted the manuscript; Chang XP and Zhang X provided analytical oversight; Xu PP and Tang ST designed and supervised the study; Chi SQ, Cao GQ, Li S, Yang DH and Li XY revised the manuscript for important intellectual content; Cao GQ and Li S offered technical or material support; Tang ST provided administrative support; all authors have read and approved the final version to be published.
Supported by the Public Welfare Research and Special Fund of the National Health and Family Planning of China, No. 201402007.
Institutional review board statement: This study was approved by the Ethics Committee of Tongji Medical College, Huazhong University of Science and Technology.
Informed consent statement: Before the consent form was signed by the parents, they were fully informed about the surgical procedure with the associated risks and the possibility of converting to open technology.
Conflict-of-interest statement: All authors stated that they have no financial relationships to disclose.
Data sharing statement: The technical appendix, statistical code, and dataset are available from the corresponding author at tshaotao83@126.com. All the participants gave informed consent for data sharing when they enrolled in this study. No additional data are available.
Open-Access: This is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Shao-Tao Tang, MD, PhD, Chief Doctor, Full Professor, Department of Pediatric Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan 430022, Hubei Province, China. tshaotao83@126.com
Telephone: +86-13720313268 Fax: +86-27-85726402
Received: October 1, 2019
Peer-review started: October 1, 2019
First decision: November 4, 2019
Revised: November 11, 2019
Accepted: November 29, 2019
Article in press: November 29, 2019
Published online: December 14, 2019
Processing time: 74 Days and 9.5 Hours
Abstract
BACKGROUND

A one-stage laparoscopic operation has recently been considered a favorable option for the management of patients with Hirschsprung's disease (HD) due to its superior cosmetic results. One-stage transanal endorectal pull-through for the treatment of rectosigmoid HD has been widely used in newborns without complications. However, enterostomy is required in some HD cases for enterocolitis and dilated colon. Our transumbilical enterostomy (TUE) and two-stage laparoscopy-assisted anorectoplasty were effective and achieved a similar cosmetic effect to one-stage laparoscopy on the abdominal wall in patients with anorectal malformation, but the effect in patients with HD is unclear.

AIM

To evaluate the safety, efficacy and cosmetic results of TUE in two-stage laparoscopy-assisted pull-through for HD.

METHODS

From June 2013 to June 2018, 53 patients (40 boys, 13 girls; mean age at enterostomy: 5.5 ± 2.2 mo) who underwent enterostomy and two-stage laparoscopy-assisted pull-through for HD with stoma closure were reviewed at our institution. Two enterostomy approaches were used: TUE in 24 patients, and conventional abdominal enterostomy (CAE) in 29 patients. Eleven patients with rectosigmoid HD had severe preoperative enterocolitis or a dilated colon. 26 patients had long-segment HD, and 16 patients had total colonic aganglionosis (TCA). The patients with left-sided HD underwent the two-stage laparoscopic Soave procedure, and the patients with right-sided HD and TCA underwent the laparoscopic Duhamel procedure. Demographics, enterostomy operative time, complications and cosmetic results were respectively evaluated.

RESULTS

There were no differences between the groups with respect to gender, age at enterostomy, weight and clinical type (P > 0.05). No conversion to open technique was required. Two patients experienced episodes of stomal mucosal prolapse in the TUE group and 1 patient in the CAE group (8.33% vs 3.45%, P > 0.05). No parastomal hernia was observed in either of the two groups. Wound infection at the stoma was seen in 1 case in the TUE group, and 2 cases in the CAE group (4.17% vs 6.90%, P > 0.05). No obstruction was noted in any of the patients in the TUE group, whereas obstruction was found in 1 patient in the CAE group. Enterocolitis was observed in 3 and 5 patients in the TUE and CAE group, respectively (12.50% vs 17.24%, P > 0.05). There was no significant difference between the TUE group and CAE group in terms of the incidence of soiling and constipation (P > 0.05). The cosmetic result using the scar score in the TUE group was better than that in the CAE group (6.83 ± 0.96 vs 13.32 ± 1.57, P < 0.05).

CONCLUSION

TUE is a safe and feasible method for the treatment of HD, and the staged enterostomy and two-stage laparoscopy-assisted pull-through achieved a similar cosmetic effect to the one-stage laparoscopic procedure.

Keywords: Hirschsprung's disease; Transumbilical enterostomy; Conventional abdominal enterostomy; Laparoscopy; Pull through; Cosmetic result

Core tip: This study describes a comparison between transumbilical enterostomy (TUE) and conventional abdominal enterostomy in a single-barreled fashion and two-stage laparoscopy-assisted pull-through in Hirschsprung's disease (HD) with stoma closure. TUE is a safe and feasible method for the treatment of HD, offering easier stoma care and better cosmetic results, and the staged enterostomy and two-stage laparoscopy-assisted pull-through achieved a similar cosmetic effect to the one-stage laparoscopic procedure.