In Brief Background: The surgical management of Hirschsprung's disease (HD) has evolved from the original 3-stage approach to the recent introduction of minimal-access single-stage techniques. We reviewed the early results of the transanal Soave pullthrough from 6 of the original centers to use it. Methods: The clinical course of all children with HD undergoing a 1-stage transanal Soave pullthrough between 1995 and 2002 were reviewed. Children with a preliminary stoma or total colonic disease were excluded. Results: There were 141 patients. Mean time between diagnosis and surgery was 32 days, and mean age at surgery was 146 days. Sixty-six (47%) underwent surgery in the first month of life. Forty-seven (33%) had the pathologic transition zone documented laparoscopically or through a small umbilical incision before beginning the anal dissection. Mean blood loss was 16 mL, and no patients required transfusion. Mean time to full feeding was 36 hours, mean postoperative hospital stay was 3.4 days, and 87 patients (62%) required only acetaminophen for pain. Early postoperative complications included perianal excoriation (11%), enterocolitis (6%), and stricture (4%). One patient died of congenital cardiac disease. Mean follow-up was 20 months; 81% had normal bowel function for age, 18% had minor problems, and 1% had major problems. Two patients required a second operation (twisted pullthrough, and residual aganglionosis). One patient developed postoperative adhesive bowel obstruction. Conclusion: To date, this report represents the largest series of patients undergoing the 1-stage transanal Soave pullthrough. This approach is safe, permits early feeding, causes minimal pain, facilitates early discharge, and presents a low rate of complications. One-hundred forty-one children with Hirschsprung disease underwent a transanal Soave pullthrough at 6 pediatric surgical centers. Complication rates were comparable to that reported for the open Soave procedure, but the transanal approach was associated with a short hospital stay, minimal pain, and absence of a visible abdominal scar.
Abstract Introduction Advances in treatment over recent years have increased the long-term survival of young, female cancer patients; unfortunately these treatments bring a significant risk of ovarian failure and infertility. This literature review aimed to determine the optimal technique for ovarian preservation in pre-menopausal women receiving pelvic radiotherapy (IMRT). The traditional method comprises surgical transposition; IMRT and other emerging techniques may offer alternative non-invasive means of sparing ovaries and minimising dose. Methods A critical review of the evidence pertaining to pelvic radiotherapy and ovarian sparing was performed. Evidence was subjected to critical appraisal using the Critical Appraisal Skills Programme tool and thematic analysis of the findings identified key issues. Results Surgical transposition appears to be a successful method of preserving ovarian function depending on the position of the ovaries outside of the radiation field, the age of the patient and the total dose received by the ovaries. There is limited modern evidence concerning its usage in relation to emerging techniques and technology. The use of IMRT is certainly widespread in the treatment of female pelvic cancers, however, there is no evidence supporting its use for reduction of ovarian dose. Several other studies have attempted to demonstrate new techniques to preserve ovarian function, but no functional outcome measures have reinforced their results. Conclusions Ovarian transposition has a proven track record for preservation of ovarian function, but the potential value of IMRT as a viable alternative to date remains unexplored. New work should be encouraged to determine the potential value of IMRT as a non-surgical alternative.
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