Cheng Tianran,Ma Ya,Li Qi.Conservative managements of anastomotic leak under ultrasonic monitoring for Hirschsprung’s disease in infants[J].Journal of Clinical Pediatric Surgery,,():825-829.[doi:10.3760/cma.j.cn101785-202209044-005]
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Conservative managements of anastomotic leak under ultrasonic monitoring for Hirschsprung’s disease in infants

Journal of Clinical Pediatric Surgery[ISSN:1671-6353/CN:43-1380/R] volume: Number: 2024 09 Page: 825-829 Column: 专题·外科便秘性疾病 Date of publication: 2024-09-01
Author(s):
Cheng Tianran1;  Ma Ya2;  Li Qi1
1. Department of General Surgery, Capital Institute of Pediatrics, Beijing 100020, China;
2. Department of Ultrasonography, Capital Institute of Pediatrics, Beijing 100020, China
Keywords:
Hirschsprung Disease; Postoperative Complications; Anastomotic Leak; Conservative Treatment; Treatment Outcome; Infant
DOI:
10.3760/cma.j.cn101785-202209044-005
Abstract:
Objective To summarize and share our institutional experience in the conservative managements of anastomotic leak in infants under ultrasonic monitoring for Hirschsprung’s disease (HD) over the last two years. Methods From January 2020 to December 2021,a HD child underwent pull-through and conservative treatment was offered for anastomotic leak.Under ultrasound monitoring,anal dilatation,catheter drainage,systemic and local anti-infection and placing anal tube under local anesthesia and sedation were performed.The outcomes were summarized. Results There were 3 girls and 1 boy.The causes were recto-sigmoid segment HD (n=2),long segment HD (n=1) and total colonic aganglionosis (n=1).Operative age was (3-11) month.Anastomosis leak occurred at Day 7/15/21/50 post-operation.All external openings were located at 6 o’clock point with presacral abscess.Three cases healed at Day 34/48/72 and 1 child underwent enterostomy.Function was satisfactory without stricture or sinus tract formation. Conclusions HD with postoperative anastomotic leak and local abscess formation may be managed conservatively under ultrasonic monitoring.Non-responsive cases should be operated as soon as possible.

References:

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[13] Ma Y,Jiang Q,Zhang ZJ,et al.Diagnosis of Hirschsprung disease by hydrocolonic sonography in children[J].Eur Radiol,2022,32(3):2089-2098.DOI:10.1007/s00330-021-08287-w.
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[15] Podevin G,Lardy H,Azzis O,et al.Technical problems and complications of a transanal pull-through for Hirschsprung’s disease[J].Eur J Pediatr Surg,2006,16(2):104-108.DOI:10.1055/s-2006-923995.
[16] Dingemans A,van der Steeg H,Rassouli-Kirchmeier R,et al.Redo pull-through surgery in Hirschsprung disease:Short-term clinical outcome[J].J Pediatr Surg,2017,52(9):1446-1450.DOI:10.1016/j.jpedsurg.2016.09.059.;tempValue2:[1] 中华医学会小儿外科学分会肛肠学组、新生儿学组.先天性巨结肠的诊断及治疗专家共识[J].中华小儿外科杂志,2017,38(11):805-815.DOI:10.3760/cma.j.issn.0253-3006.2017.11.002. Group of Anorectum,Branch of Neonatology,Society of Pediatric Surgery,Chinese Medical Association:Guidelines of Diagnosing and Treating Hirschspung’s disease[J].Chin J Pediatr Surg,2017,38(11):805-815.DOI:10.3760/cma.j.issn.0253-3006.2017.11.002.
[2] 中华医学会小儿外科学分会内镜外科学组.腹腔镜先天性巨结肠症手术操作指南(2017版)[J].中华小儿外科杂志,2017,38(4):247-254.DOI:10.3760/cma.j.issn.0253-3006.2017.04.002. Section of Laparoendoscopy,Branch of Pediatric Surgery,Chinese Medical Association:Guideline for Laparoscopic Pull-through for Hirschsprung’s Disease (Edition 2017)[J].Chin J Pediatr Surg,2017,38(4):247-254.DOI:10.3760/cma.j.issn.0253-3006.2017.04.002.
[3] Holschneider AM,Puri P.Hirschsprung’s disease and allied disorders[M].3rd ed.Berlin:Springer,2008:115.
[4] Lu CG,Hou GJ,Liu CY,et al.Single-stage transanal endorectal pull-through procedure for correction of Hirschsprung disease in neonates and nonneonates:A multicenter study[J].J Pediatr Surg,2017,52(7):1102-1107.DOI:10.1016/j.jpedsurg.2017.01.061.
[5] Chi SQ,Guo JL,Zhang X,et al.Resuturing without enterostomy for the treatment of early-stage anastomotic leaks after laparoscopic soave procedure in Hirschsprung’s disease[J].J Laparoendosc Adv Surg Tech A,2020,30(12):1295-1300.DOI:10.1089/lap.2020.0640.
[6] Engum SA,Grosfeld JL.Long-term results of treatment of Hirs-chsprung’s disease[J].Semin Pediatr Surg,2004,13(4):273-285.DOI:10.1053/j.sempedsurg.2004.10.015.
[7] Pratap A,Gupta DK,Shakya VC,et al.Analysis of problems,complications,avoidance and management with transanal pull-through for Hirschsprung disease[J].J Pediatr Surg,2007,42(11):1869-1876.DOI:10.1016/j.jpedsurg.2007.07.017.
[8] 彭春辉,陈亚军,张廷冲,等.先天性巨结肠症术后早期有症状吻合口漏的治疗与转归[J].中华小儿外科杂志,2018,39(12):895-899.DOI:10.3760/cma.j.issn.0253-3006.2018.12.004. Peng CH,Chen YJ,Zhang TC,et al.Treatments and outcomes of early symptomatic anastomotic leakage after pull-through procedure for Hirschsprung’s disease[J].Chin J Pediatr Surg,2018,39(12):895-899.DOI:10.3760/cma.j.issn.0253-3006.2018.12.004.
[9] Pini-Prato A,Mattioli G,Giunta C,et al.Redo surgery in Hirschsprung disease:what did we learn? Unicentric experience on 70 patients[J].J Pediatr Surg,2010,45(4):747-754.DOI:10.1016/j.jpedsurg.2009.08.001.
[10] Li Q,Zhang Z,Xiao P,et al.Surgical approach and functional outcome of redo pull-through for postoperative complications in Hirschsprung’s disease[J].Pediatr Surg Int,2021,37(10):1401-1407.DOI:10.1007/s00383-021-04965-4.
[11] 李颀,张震,肖萍,等.再次手术治疗先天性巨结肠初次根治术后中远期并发症的临床研究[J].中华小儿外科杂志,2021,42(7):639-645.DOI:10.3760/cma.j.cn421158-20200309-00153. Li Q,Zhang Z,Xiao P,et al.Redo pull-through for late postoperative complications of Hirschsprung’s disease[J].Chin J Pediatr Surg,2021,42(7):639-645.DOI:10.3760/cma.j.cn421158-20200309-00153.
[12] 马亚,李颀,张震,等.超声对先天性巨结肠术后并发症的诊断价值[J].中国医学影像学杂志,2021,29(1):60-64.DOI:10.3969/j.issn.1005-5185.2021.01.015. Ma Y,Li Q,Zhang Z,et al.Diagnostic value of ultrasonography for postoperative complications of Hirschsprung disease[J].Chin J Med Imaging,2021,29(1):60-64.DOI:10.3969/j.issn.1005-5185.2021.01.015.
[13] Ma Y,Jiang Q,Zhang ZJ,et al.Diagnosis of Hirschsprung disease by hydrocolonic sonography in children[J].Eur Radiol,2022,32(3):2089-2098.DOI:10.1007/s00330-021-08287-w.
[14] Peng CH,Chen YJ,Pang WB,et al.STROBE-anastomotic leakage after pull-through procedure for Hirschsprung disease[J].Medicine (Baltimore),2018,97(46):e13140.DOI:10.1097/MD.0000000000013140.
[15] Podevin G,Lardy H,Azzis O,et al.Technical problems and complications of a transanal pull-through for Hirschsprung’s disease[J].Eur J Pediatr Surg,2006,16(2):104-108.DOI:10.1055/s-2006-923995.
[16] Dingemans A,van der Steeg H,Rassouli-Kirchmeier R,et al.Redo pull-through surgery in Hirschsprung disease:Short-term clinical outcome[J].J Pediatr Surg,2017,52(9):1446-1450.DOI:10.1016/j.jpedsurg.2016.09.059.

Memo

收稿日期:2022-9-23。
基金项目:北京市属医院科研培育项目(PX2020054)
通讯作者:李颀,Email:35036091@qq.com

Last Update: 1900-01-01