Bowel function and fecal continence after Soave’s trans-anal endorectal pull-through for Hirschsprung’s disease: a local experience

Abstract

The aim of this study was to evaluate the postoperative clinical outcome, colorectal function, and fecal continence score after Soave's transanal endorectal pull-through surgery (TERPT) for Hirschsprung's disease (HD) comparing them in preschool and school children with the results of younger children. This comparative retrospective study was done on 40 HD children treated over a period of 8 years from January 2001 to December 2008. Patients were classified into two equal groups according to their age: group I (n = 20) included children with age <6 months up to 42 months, and group II (n = 20) included children from 3.5 years up to 13 years. Demographic, clinical data, preoperative investigations, operative records, postoperative outcome and follow-up including defecation problems, fecal continence score rate (FCSR), anal manometry and electromyography were all reviewed. Obtained data were statistically analyzed using SPSS. Forty patients were included in this study, 28 males and 12 females with the male to female ratio of 2.3:1. The median age of the studied patients in group I was 8.9 months, while in group II, the median age was 65.95 months. The postoperative follow-up period ranged from 18 to 24 months in group I with a mean of 21 months, while it ranged from 2 to 26 months in group II. In group I, most of children showed no abnormal defecation problems, 16 patients had excellent FCSR, 4 were having good FCSR and no poor continence score rate, while 3 patients suffered from constipation. Meanwhile, in group II, 15 patients showed excellent FCSR in 10 patients and 5 with good FCSR. While the rest of patients suffered from different abnormal defecation behavior that was constipation in 5 patients. The remaining 5 patients suffered from continence problems varying from fair in 3 patients (20%), with the remaining 2 patients having a poor continence score rate. It can be concluded that TERPT can be performed with some difficulties in older children; yet, the follow-up results are statistically low when compared with those patients who had undergone the operation at younger age.

Are all patients with short segment Hirschsprung’s disease equal? A retrospective multicenter study

“…The median ages at diagnosis and the time of pullthrough operation were 1.5 months (range: 0. The current study focused on the patients after transanal endorectal pullthrough procedure which is one of the most popular operations for short segment HSCR in recent years after multiple studies showing its favorable results compared to other techniques [11][12][13][14]. Only one operation was chosen in order to minimize the difference related to the surgical procedure.…”

Literature Review of the Outcome after One-Stage Transanal Endorectal Pull-Through Procedure for Hirschsprung’s Disease in Children

“…Of 14 published articles 11 were included [2][3][4][5][6][7][8][9][10][11][12][13][14][15]. A total of 297 children were included in the selected material and the demography of the children included in the survey is summarized in Table 1.…”

“…The problem is that the authors do not specify which patients had incontinence or constipation; they focused on stool problems; including both. They found a total of 5 children with problems but there was not a significantly higher number in either age group [3].…”

“…22 of these 105 studied children were reported incontinent [3,10,13,14]. One report shows that 11 out of 16 patients (69%) had incontinence problems [14].…”

“…The authors divided the children into a younger group (6 months -3.5 years) that had no incontinence and an older group (3.5 -13 years) where some patients had problems with their stools. Unfortunately the exact number of patients who suffered from incontinence was not reported since the authors did not specify which patients had incontinence or constipation, as they focused only on stool problems [3]. One report found a correlation between trisomy 21 and incontinence described in 1 out of 20 patients (5%) [10].…”