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Hirschsprung disease (HD) is a rare congenital disorder of the enteric nervous system, affecting approximately 1 in 5,000 live births. It is characterized by the absence of ganglion cells in the distal colon, leading to functional intestinal obstruction due to impaired peristalsis. Surgical treatment consists of resection of the aganglionic segment-most commonly rectosigmoid-followed by a colo-rectal, colo-anal, or ileo-anal anastomosis.
Among colo-anal pull-through procedures, the Swenson technique was historically performed through an exclusively transanal approach, which carries a risk of sphincter injury correlated with operative duration. More recently, combined laparoscopic and transanal approaches have been developed to reduce this risk, although they may be associated with higher overall complication and reoperation rates.
The Swenson procedure can be performed using a single-port laparoscopic approach, a technique that is sparsely described in the literature and rarely practiced in France. Single-port laparoscopy represents an emerging surgical technique that, despite increased technical complexity for surgeons, may further enhance postoperative recovery and cosmetic outcomes compared to conventional multiport laparoscopy.
The objective of this study is to describe the outcomes of single-port laparoscopic Swenson pull-through in children with Hirschsprung disease and to compare them with outcomes obtained using more conventional approaches, namely exclusive transanal surgery or combined multiport laparoscopic and transanal approaches.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| SIL-Swenson | Swenson coloanal pullthrough with single incision laparoscopy |
| |
| CL-Swenson | Swenson coloanal pullthrough with conventional (multiport) laparoscopy |
| |
| TA-Swenson | Swenson coloanal pullthrough with exclusive trananal approach |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| transanal or laparoscopy assisted Swenson coloanal pullthrough | Procedure | TA-Swenson consist of total trananal endorectal pullthrough after a short submucosal dissection of the last part of the rectum. Laparoscopy-assisted Swenson pull-through consists of laparoscopic mobilization of the aganglionic colon with intraoperative level confirmation, followed by a transanal resection of the aganglionic segment and a primary coloanal anastomosis |
| Measure | Description | Time Frame |
|---|---|---|
| To compare the short-term effectiveness of different surgical laparoscopic approaches used for the Swenson technique. | Short-term effectiveness, defined as spontaneous bowel transit without obstructive-spectrum events during the first postoperative year, including:
| From surgery to 12 months postoperatively |
| Measure | Description | Time Frame |
|---|---|---|
| To compare intraoperativensurgical efficiency according to surgical approach | Surgical efficiency, defined as operative time for coloanal anastomosis completion without conversion, including the approach for intraoperative frozen-section biopsy. | During surgery (day 0) |
| To compare immediate postoperative recovery |
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Inclusion Criteria:
Exclusion criteria
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Children under 16 years of age with diagnosis of Hirschsprung disease confirmed by initial rectal biopsy and postoperative pathological examination
| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| SCHMITT Françoise | Contact | 0241353637 | +33 | FrSchmitt@chu-angers.fr |
| SCHMITT Françoise | Contact | FrSchmitt@chu-angers.fr |
| Name | Affiliation | Role |
|---|---|---|
| SCHMITT Françoise | University Hospital of Angers | Study Chair |
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| ID | Term |
|---|---|
| D006627 | Hirschsprung Disease |
| ID | Term |
|---|---|
| D004065 | Digestive System Abnormalities |
| D004066 | Digestive System Diseases |
| D008531 | Megacolon |
| D003108 | Colonic Diseases |
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|
Recovery, defined as hospital discharge in good health, which includes:
|
| At hospital discharge (average 5 days) |
| Short-term complications | All early postoperative complications graded according to the Clavien-Madadi classification | From hospital discharge to 30 days after surgery |
| Long-term complications | All late postoperative complications graded according to the Clavien-Madadi classification | From 31 days after surgery up to the last clinical follow-up visit (mean follow-up: 5.5 years) |
| Long-term continence outcomes | Assessed using the Krickenbeck score, which includes:
| Assessed after toilet training age (≥3-4 years old) and up to the last clinical follow-up visit (mean follow-up: 5.5 years) |
| D007410 |
| Intestinal Diseases |
| D005767 | Gastrointestinal Diseases |
| D000013 | Congenital Abnormalities |
| D009358 | Congenital, Hereditary, and Neonatal Diseases and Abnormalities |