A Bicenter Retrospective Comparative Study of the Surgical Approach for the Treatment of Hirschsprung Disease Using the Swenson Technique
试验速览
- 阶段
- 不适用
- 状态
- 尚未招募
- 发起方
- 入组人数
- 70
- 主要终点
- To compare the short-term effectiveness of different surgical laparoscopic approaches used for the Swenson technique.
研究概览
简要总结
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.
研究设计
- 研究类型
- Observational
- 观察模型
- Cohort
- 时间视角
- Retrospective
入排标准
- 年龄范围
- — 至 16 Years（Child）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Children under 16 years of age
- •Diagnosis of Hirschsprung disease confirmed by initial rectal biopsy and postoperative pathological examination
- •Primary Swenson coloanal pull-through performed at Angers or Caen University Hospital between January 1, 2010 and June 30, 2025
排除标准
- •Parental or legal guardian opposition to the use of medical data for research purposes
- •Hirschsprung disease treated with other surgical techniques (Duhamel, Soave, De La Torre, TERPT)
- •Patients operated on in another hospital
- •Patients who underwent rectosigmoid resection for causes of constipation other than Hirschsprung disease
研究组 & 干预措施
SIL-Swenson
Swenson coloanal pullthrough with single incision laparoscopy
干预措施: transanal or laparoscopy assisted Swenson coloanal pullthrough (Procedure)
CL-Swenson
Swenson coloanal pullthrough with conventional (multiport) laparoscopy
干预措施: transanal or laparoscopy assisted Swenson coloanal pullthrough (Procedure)
TA-Swenson
Swenson coloanal pullthrough with exclusive trananal approach
结局指标
主要结局
To compare the short-term effectiveness of different surgical laparoscopic approaches used for the Swenson technique.
时间窗: From surgery to 12 months postoperatively
Short-term effectiveness, defined as spontaneous bowel transit without obstructive-spectrum events during the first postoperative year, including: * Constipation * Delayed resumption of oral feeding * Sphincter hypertonicity * Hirschsprung-associated enterocolitis
次要结局
- To compare intraoperativensurgical efficiency according to surgical approach(During surgery (day 0))
- To compare immediate postoperative recovery(At hospital discharge (average 5 days))
- Short-term complications(From hospital discharge to 30 days after surgery)
- Long-term complications(From 31 days after surgery up to the last clinical follow-up visit (mean follow-up: 5.5 years))
- Long-term continence outcomes(Assessed after toilet training age (≥3-4 years old) and up to the last clinical follow-up visit (mean follow-up: 5.5 years))