Fecal incontinence after single-stage Soave’s pull-through: abdominal versus transanal endorectal pull-through

Purpose To compare the postoperative fecal continence and bowel functions between patients who underwent a single stage - Soave’s endorectal pull through operations whether via the classic abdominal endorectal pull through approach (TAPT) or trans-anal endorectal pull through approach (TERPT).Patients and Methods This retrospective study was performed on 50 HD consecutive patients who had undergone surgery during a period of 5 years from January 2002 to January 2007. They were two equal groups; group I (n=25) including patients who underwent TAPT; group II (n=25) including patients who underwent TERPT. Demographic, clinical data, preoperative investigations, operative records, postoperative outcome were studied. Post operative fecal continence score rate (FCSR) was assessed in children over the age of 4 years. Moreover, those with poor FCSR were further investigated by magnetic resonance imaging (MRI). Electromyography (EMG) and anorecatal manometery (AM) were also used in follow-up.Results Twenty six patients (52%) had an excellent FCSR and eighteen patients (36%) showed good FCSR. However, 5 patients (10%) had a fair FCSR and only 1 patient (2%) suffered of a poor FCSR. There was no statistical significant difference between the two groups in neither anal manometry nor EMG. MRI did not show any abnormalities on pelvic floor and anal muscle complex on those patients who had fair or poor FCSR.Conclusion The incidence of fecal incontinence is very low after Soave’s pull-through operations whether TAPT or TERPT approaches with no statistical significant difference.Keywords: fecal continence, Hirschsprung’s disease, Soave’s operation, transanal endorectal pull-throug

Minimally invasive video-assisted thyroidectomy: reflections after more than 2400 cases performed

BACKGROUND: The minimally invasive video-assisted approach was developed for primary hyperparathyroidism in 1997 and the year after for thyroid disease. Since then, the technique has been adopted worldwide, and indications moved from the initial benign disease to low-risk and intermediate-risk carcinoma, demonstrating a level of oncologic radicality comparable to the conventional open approach when inclusion criteria are strictly respected. METHODS: Between 1998 and 2014, 2412 minimally invasive video-assisted thyroidectomies (MIVAT) were performed in our department. The indication for surgery in 825 patients (34.3 %) was a malignant tumor, in particular, a papillary carcinoma in 800 patients. Among them, 528 patients operated on between 2000 and 2009 had a mean complete follow-up of 7.5 (standard deviation, 2.3) years. RESULTS: A total thyroidectomy was performed in 1788 patients (74.1 %) and a hemithyroidectomy in 564 (23.4 %). Also performed was central compartment lymphadenectomy in 31 patients (1.3 %) and parathyroidectomy for the presence of a solitary parathyroid adenoma in 29 (1.2 %). Mean duration of the procedure was 41 (standard deviation, 14) minutes. After a mean follow-up of 7. 5 years, 528 patients who underwent MIVAT for low-risk or intermediate-risk papillary carcinoma presented a cure rate of 85 % (undetectable thyroglobulin), comparable with the 80 % rate reported in patients who had undergone open thyroidectomy during the same period. CONCLUSIONS: After a long experience and a considerable number of procedures performed in a single center, MIVAT is confirmed as a safe operation, with a complication rate comparable with open thyroidectomy. MIVAT offers a cure rate for the treatment of low-risk and intermediate-risk malignancies that is comparable with an open procedure when inclusion criteria are strictly respected