The preliminary study of modified Swenson procedure in Hirschsprung disease

Abstract Purpose We have been using the Swenson procedure for more than 3 decades for Hirschsprung disease (HD). Recently, we modified this procedure, leaving the anterior wall below the peritoneal reflection undissected (mSwen). In 2000, we introduced mSwen with laparoscopic guidance (LapmSwen). We...

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Bibliographic Details
Published in:Journal of pediatric surgery 2009-08, Vol.44 (8), p.1560-1563
Main Authors: Yokoi, Akiko, Satoh, Shiiki, Takamizawa, Shigeru, Muraji, Toshihiro, Tsugawa, Chikara, Nishijima, Eiji
Format: Article
Language:English
Subjects:
Blood Loss, Surgical
Colostomy
Digestive System Surgical Procedures - methods
Female
Hirschsprung disease
Hirschsprung Disease - surgery
Humans
Infant
Laparoscopy
Male
Pediatrics
Postoperative Complications
Retrospective Studies
Statistics, Nonparametric
Surgery
The Swenson Procedure
Time Factors
Treatment Outcome
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Summary:Abstract Purpose We have been using the Swenson procedure for more than 3 decades for Hirschsprung disease (HD). Recently, we modified this procedure, leaving the anterior wall below the peritoneal reflection undissected (mSwen). In 2000, we introduced mSwen with laparoscopic guidance (LapmSwen). We hypothesized that (1) omitting anterior wall dissection would not affect postoperative anorectal function, and (2) reduced dissection with better visualization via laparoscopy would reduce operative risks. Method Charts of 89 patients with Hirschsprung disease operated on between 1990 through 2005 were retrospectively reviewed. Comparisons between Swen and mSwen, as well as between mSwen and LapmSwen, were analyzed in terms of operating time, blood loss, and complications. Results Mean operating times (minutes) were 312 for Swen, 284 for mSwen ( P = .152), and 302 for LapmSwen ( mSwen, P = .218). Mean blood loss (mL) were 64.8 for Swen, 60.3 for mSwen ( P = .669), and 8.7 for LapmSwen (as compared to mSwen, P = .001). We noted leakage in 7 Swen, 2 mSwen, and no LapmSwen patients. There were no significant differences between Swen and mSwen, or between mSwen and LapmSwen, in the incidence of enterocolitis, constipation, and soiling. Conclusion LapmSwen appeared to be comparable to the standard and modified Swenson procedures in most measures. Operative blood loss may be reduced in the LapmSwen approach.
ISSN:0022-3468
1531-5037
DOI:10.1016/j.jpedsurg.2008.11.056