Clinical trial NCT06880666: Minimally Invasive Surgical Intervention for Hirschsprung Disease
Official title: Minimally Invasive Surgical Intervention for Hirschsprung Disease: A Prospective Study on Efficacy and Long-term Functional Outcomes for Neonatal Patients
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Hirschsprung Disease
Keywords: Aganglionic bowel
Minimally invasive
Laparoscopic
Single incision
Pediatric
Hirschsprung
Lead sponsor: National Children's Hospital, Vietnam
Sponsor class: OTHER
First posted: 2025-03-18
Enrollment: 23
Sex: ALL
Maximum age (years): 18
Standard ages: CHILD
ADULT
Accepts healthy volunteers: no
Allocation: NA
Intervention model: SINGLE_GROUP
Primary purpose: TREATMENT

Brief summary: Hirschsprung's disease (HD) is one of the most common congenital conditions, with a global incidence of 1/5000 newborns; the prevalence in the Vietnamese population is even higher. The absence of enteric ganglia in the distal bowel causes intestinal obstruction and delayed meconium passage in newborns, as well as failure of normal defecation later in life. If left untreated, HD can lead to life complications such as enterocolitis and even death. Standard treatment involves surgical resection of the affected bowel segment, with minimally invasive laparoscopic techniques offering reduced postoperative complications, shorter hospital stays, and faster recovery compared to open surgery. Since 2012, the National Children Hospital has been the first institution in Vietnam to routinely use the minimally invasive surgical approach for HD. However, due to a lack of research funding and patients' financial constraints to travel to post-operative treatment centers, there has yet to be a publication addressing the long-term outcomes and associated abnormalities of all patients treated with SILS. Thus, the purpose of this study is to report on the safety, efficacy, and long-term functional outcomes and cosmesis results of minimally invasive surgeries performed on HD neonatal patients at The National Children's Hospital from 2020 to 2021, thus optimize surgical management and improve patient outcomes in a lower-middle-income country setting.

Detailed description: Hirschsprung's disease (HD) is one of the most common congenital disorders affecting the gastrointestinal tract, with a global incidence of approximately 1 in 5,000 live births. However, studies suggest that the prevalence is notably higher in the Vietnamese population. The condition arises due to the absence of enteric ganglion cells in the distal colon, leading to a functional obstruction that prevents normal bowel motility. This defect results in delayed meconium passage in newborns, severe constipation, abdominal distension, and feeding intolerance. If left untreated, HD can progress to life-threatening complications such as Hirschsprung-associated enterocolitis (HAEC), bowel perforation, sepsis, and even death.

Surgical intervention remains the mainstay of treatment for HD, with the goal of resecting the aganglionic bowel segment and restoring normal intestinal function. Traditionally, open pull-through procedures were the standard approach, but advancements in minimally invasive surgery (MIS) have led to the widespread adoption of laparoscopic techniques. Georgeson's traditional three-port laparoscopic rectal pull-through technique, first introduced in 1995, has been widely used as the standard treatment for HD. The first case of single-incision laparoscopic assisted rectal pull-through (SILS) surgery for HD was published in 2010, in which six patients who underwent SILS all had positive outcomes and excellent cosmesis. Compared to conventional open surgery, laparoscopic approaches offer several benefits, including reduced postoperative pain, fewer wound-related complications, shorter hospital stays, improved cosmetic outcomes, and faster overall recovery. Despite the promising outcomes of minimally invasive surgical intervention, 15 years after the first reported case, only a few articles (a total of 9 articles reported in Pubmed) have been published to evaluate SILS in HD.

Since 2012, the Vietnam National Children's Hospital (NCH) has been a pioneer in the routine use of the minimally invasive surgical technique for the treatment of Hirschsprung's disease in Vietnam. However, despite over a decade of experience with this method, research on long-term outcomes in Vietnamese patients remains scarce. A major challenge has been the limited availability of research funding and the financial difficulties faced by many families, which prevent regular postoperative follow-ups and comprehensive long-term studies. As a result, there is currently no published data evaluating the long-term safety, efficacy, and potential postoperative complications associated with minimally invasive intervention for HD in this specific patient population.

The primary objective of this study is to bridge this knowledge gap by systematically analyzing the outcomes of pediatric patients who underwent minimally invasive surgical intervention for Hirschsprung's disease at NCH between 2020 and 2021. The study aims to assess key factors such as perioperative outcomes, postoperative bowel function, the incidence of complications such as anastomotic stricture or incontinence, associated abnormalities/ comorbidities, cosmesis, and quality of life improvements. By providing robust clinical evidence, this research will contribute to optimizing surgical management strategies for Hirschsprung's disease in resource-limited settings, ultimately improving patient outcomes and guiding future surgical practices in Vietnam and other LMICs.

Eligibility criteria: Inclusion Criteria:

* Age: From 1 to 28 days old
* Diagnosis: Hirschsprung disease was diagnosed based on clinical presentation, intraoperative frozen section biopsy, and postoperative histopathological findings showing absence of ganglion cells.
* Surgical Approach: Patients underwent SILEP through a single periumbilical incision, with no additional abdominal incisions. All surgeries were conducted by the same team, and postoperative care was provided according to a standardized protocol.
* Parents or guardians provided consent to participate in the study and committed to following the scheduled follow-up visits.

Exclusion Criteria:

* Patients exhibiting severe HAEC, bowel obstruction, or peritonitis at the time of operation
* Those with a history of failed Hirschsprung disease surgery, prior abdominal operations, or colostomy
* Individuals with contraindications to laparoscopic procedures, such as bleeding disorders or significant congenital heart defects
* Cases where parents or legal guardians refused consent for study participation

Primary outcomes:
measure: Volume of Blood Loss
timeFrame: Perioperative
measure: Conversion to open surgery
timeFrame: Perioperative
measure: Operative time
timeFrame: Perioperative
measure: Mortality and severe morbidity
timeFrame: Through study completion, an average of 4 years
measure: Early postoperative complications
timeFrame: Up to 8 weeks post-operation
measure: Rintala score
timeFrame: Through study completion, an average of 4 years
measure: Manchester Scar Scale
timeFrame: Through study completion, an average of 4 years
Secondary outcomes:
measure: Associated conditions
timeFrame: Through study completion, an average of 4 years
Other outcomes:
Locations:
city: Hanoi
country: Vietnam
facility: Department of Surgery, The National Children Hospital
Study officials:
affiliation: Department of Pediatric Surgery, The National Hospital of Pediatrics, Hanoi, Vietnam
name: Quang T Nguyen, M.D.
role: PRINCIPAL_INVESTIGATOR
References:
citation: Liu, M., Fang, Y., Zhang, B., Lin, Y., Li, O., Bai, J., … & Wu, D. (2020). Laparoscopic-assisted soave operation for the treatment of hirschsprung disease in children: 5 years of experience.. https://doi.org/10.21203/rs.3.rs-18886/v1
citation: LÊ NH. ĐÁNH GIÁ KẾT QUẢ PHẪU THUẬT BỆNH GIÃN ĐẠI TRỰC TRÀNG BẨM SINH Ở NGƯỜI LỚN TẠI BỆNH VIỆN VIỆT ĐỨC. 2020
citation: Puri P, Nakamura H. Epidemiology and Clinical Characteristics of Hirschsprung's Disease. In: Hirschsprung's Disease and Allied Disorders
citation: Mayo Clinic. Hirschsprung's disease - Symptoms and causes 2021
citation: Georgeson KE, Robertson DJ. Laparoscopic-assisted approaches for the definitive surgery for Hirschsprung's disease. Semin Pediatr Surg. 2004 Nov;13(4):256-62. doi: 10.1053/j.sempedsurg.2004.10.013.
citation: Zimmermann P, Martynov I, Perger L, Scholz S, Lacher M. 20 Years of Single-Incision-Pediatric-Endoscopic-Surgery: A Survey on Opinion and Experience Among International Pediatric Endosurgery Group Members. J Laparoendosc Adv Surg Tech A. 2021 Mar;31(3):348-354. doi: 10.1089/lap.2020.0797. Epub 2020 Dec 31.
citation: Xia X, Li N, Wei J, Zhang W, Yu D, Zhu T, Feng J. Single-incision laparoscopic versus conventional laparoscopic surgery for Hirschsprung's disease: A comparison of medium-term outcomes. J Pediatr Surg. 2016 Mar;51(3):440-3. doi: 10.1016/j.jpedsurg.2015.10.051. Epub 2015 Oct 24.
citation: Fearmonti R, Bond J, Erdmann D, Levinson H. A review of scar scales and scar measuring devices. Eplasty. 2010 Jun 21;10:e43.
citation: Nguyen LT, Nguyen AT, Nguyen QT, Tran QA, Bui HD, Pham HD. Suspension sutures facilitate single-incision laparoscopic-assisted rectal pull-through for Hirschsprung disease. BMC Surg. 2021 May 31;21(1):274. doi: 10.1186/s12893-021-01260-w.
citation: Ure BM, Rintala RJ, Holschneider AM. Scoring postoperative results. Anorectal Malformations Child Embryol Diagnosis, Surg Treat Follow. 2006;351-9.
citation: Muensterer OJ, Chong A, Hansen EN, Georgeson KE. Single-incision laparoscopic endorectal pull-through (SILEP) for hirschsprung disease. J Gastrointest Surg. 2010 Dec;14(12):1950-4. doi: 10.1007/s11605-010-1299-3. Epub 2010 Aug 18.
citation: Amiel J, Lyonnet S. Hirschsprung disease, associated syndromes, and genetics: a review. J Med Genet. 2001 Nov;38(11):729-39. doi: 10.1136/jmg.38.11.729.