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Year 2013 Vol. 21 No 2
GENERAL AND SPECIAL SURGERY
S.N. NAVRUZOV1, M.M. MIRZAKHMEDOV2, B.S. NAVRUZOV3, M.A. AHMEDOV3
PECULIARITIES OF CLINICAL COURSE AND CHOICE OF SURGICAL TREATMENT OF HIRSCHPRUNG’S DISEASE IN ADULTS
Republican Oncological Scientific Center of the Ministry of Health of the Republic of Uzbekistan 1,
Coloproctology Scientific Center of the Republic of Uzbekistan 2, Tashkent,
Tashkent Medical Academy 3,
The Republic of Uzbekistan
Objectives. To improve diagnostics and determine the most effective ways of operative treatment in case of Hirschsprung’s disease in adults.
Methods. 82 patients with Hirschsprung’s disease (HD) undergoing examination and treatment during the period of 1990 up to 2013 yrs. in the Scientific Center of Coloproctology of the Ministry of Health of the Republic of Uzbekistan were included in the research. The age of patients varied from 15 up to 46 years. Out of 82 patients, 58 (70,7%) were males, 24 were females (29,3%). All patients underwent clinical and instrumental examination. For the comparative analysis of surgical treatment effectiveness the patients with HD were subdivided into 2 groups. The main group included 28 patients who underwent the abdominal-anal resection (BAR) of the rectum with the relegation of the proximal colon to the anal canal. The control group included 44 patients who underwent Duhamel operation. Outcomes of interventions and complications were analyzed. The long-term results of surgical treatment were evaluated using Visick score.
Results. Out of 82 surveyed patients the supraanal form of hypogangliosis was detected in 46 (56%), rectal one – in 20 (24,4%), recto-sigmoid – in 13 (15,9%), left-side one – in 2 (2,5%) and – 1 (1, 2%) subtotal form. According to Swenson biopsy data agangliosis was revealed in 36 (44%) out of 82 patients, hypogangliosis of the rectum in 46 (56%). In the main group the early postoperative complications were registered in 4 (14, 3%) patients and in the control group – in 14 (31,8%) patients. Lethal outcome was registered in 1 (2,2%) case after Duhamel operation. Late postoperative complications were revealed in 7,1% in the main group and 15% in the control group of patients.
Conclusions. The most adequate and radical way to treat HD in adults is considered to be the abdominal-anal resection of the rectum with relegation of the proximal colonic segments to the anal canal. It is aimed at the removal of hypo-or agangliosis zone and the decompensated segments of the colon and meets the requirements of radicalism.
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100060, Respublika Uzbekistan, g. Tashkent, ul. S. Azimova, d. 74, Respublikanskaia klinicheskaia bol'nitsa ¹1., Respublikanskii nauchnyi tsentr koloproktologii MZ Uzbekistana,
Mirzakhmedov Murad Mirkhaidarovich
Navruzov S.N. MD, professor, director of the Republican oncological scientific center of the Ministry of Health of the Republic of Uzbekistan.
Mirzakhmedov M.M. PhD, senior researcher of the Coloproctology Scientific center of the Republic of Uzbekistan.
Navruzov B.S. MD, associate professor of the chair of the general profile physician in surgery of Tashkent Medical Academy.
Ahmedov M.A. MD, professor of the chair of the general profile physician in surgery of Tashkent Medical Academy.