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Minimally invasive treatment for Hirschsprung disease
Author(s) -
Simona-Gabriela Tudorache,
Bucureşti Spitalul Clinic de Urgenţă pentru Copii „Grigore Alexandrescu“,
Felix Negoiţescu,
Laura Niculescu,
Universitatea de Medicină şi Farmacie „Carol Davila“ Bucureşti
Publication year - 2015
Publication title -
romanian medical journal
Language(s) - English
Resource type - Journals
eISSN - 2069-606X
pISSN - 1220-5478
DOI - 10.37897/rmj.2015.3.15
Subject(s) - medicine , hirschsprung's disease , laparoscopy , surgery , general surgery , invasive surgery , minimally invasive procedures , pediatric surgeon , disease , pediatric surgery
Introduction. Harold Hirschsprung, a physician at Queen Louise Children’s Hospital of Copenhagen, first described the disease that now bears his name, at the Pediatric Congress of Berlin in 1886. Since then there have been countless debates on the optimal surgical approach. This paper aims both to recap the main classical surgical techniques: Swenson, Duhamel and Soave, but the main focus is on minimally invasive techniques. Surgical techniques. In the last 25 years, the treatment for Hirschsprung disease has progressed. If classically the preferred treatment was in 2-3 stages, now the definitive intervention is per primam in most cases, thus avoiding the morbidity associated with stomas. In 1995, Georgeson describes the minimally invasive approach using laparoscopy, and then in 1998, De la Torre et al, describes the first transanal endorectal pull-through (TERPT), unattended laparoscopically. Discussions. The initial discussions were linked to comparing processes in a single stage with ones in 2 or 3 stages, finding similar results, it is now a question of comparing open techniques with minimally invasive and even minimally invasive techniques with each other, endeavoring to establish whether laparoscopically assisted approach is needed or if the transanal one is enough. Conclusion. Usually shorter forms of Hirschsprung disease are treated strictly using the transanal technique, for the forms involving the left and transverse colon laparoscopically assisted transanal pull-through is used, while for the ascending colon and for the total aganglionosis the laparoscopically assisted Duhamel procedure is preferred.

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