Background: Laparoscopic surgery is widely used in the treatment of Hirschsprung's disease (HD). However, constipation and soiling are still the main long-term complications. A new type of anastomosis, which is characterized by a heart-shaped colorectal anastomosis after splitting the posterior rectum wall to 0.5 cm above the dentate line, has been improved by our medical center. The purpose of this study was to determine the long-term effects of laparoscope-assisted heart-shaped anastomosis (LHSA) and to compare it with a more generally applied approach, the laparoscope-assisted Soave procedure (LSP).
Patients and methods: In this retrospective study, we investigated the symptoms of chronic constipation and soiling in 56 patients after LHSA and 54 patients after LSP between 2005 and 2011.
Results: For LHSA, the median age at surgery was 1.4 years (0.2-7.3), and the median follow-up time was 7.1 years (5-11.3). For LSP, the median age at surgery was 1.2 years (0.1-6.2) and the median follow-up time was 7.0 years (5-9.3). Constipation was less frequent after LHSA than after LSP (7.1 versus 22.2%, P = .025), but there was no difference in the frequency of soiling after LHSA compared with that after LSP (8.9 versus 14.8%, P = .339).
Conclusions: The improved anastomosis (LHSA) preserves most of the internal anal sphincter, and the wide anastomosis prevents stenosis as well. In the long-term follow-up results, the incidence of constipation after LHSA declined when compared with that after LSP, and soiling showed a satisfactory result. Our medical center has performed laparotomy-assisted heart-shaped anastomosis since the 1990s and LHSA since the 2000s. Because it is easy to learn and provide good outcomes, many medical centers in China have adopted the heart-shaped anastomosis to treat HD. Using the LHSA method to manage the affected bowel provides satisfactory long-term outcomes, that is, avoiding constipation and soiling. Thus, LHSA may provide a new choice for HD operations.
Keywords: Hirschsprung's disease; laparoscope-assisted heart-shaped anastomosis; long-term follow-up.