Duhamel and Transanal Endorectal Pull-throughs for Hirschsprung' Disease: A Systematic Review and Meta-analysis

Seo, Shogo; Hock, Alison; Koike, Yuhki; Chen, Yong; Lee, Carol; Li, Bo; Pierro, Agostino

doi:10.1055/s-0037-1607061

Cited by 33 publications

(19 citation statements)

References 28 publications

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“…The incidence of HAEC following pull-through procedures shows wide variation across studies, primarily due to varied de nitions of HAEC. Almost all comparative analyses show no signi cant difference in HAEC rates between Duhamel and TERP procedures [7,14]. In our study, pre-operative HAEC was observed in 7% of the MDPT group and 3.1% in the TERP group.…”

Section: Haeccontrasting

confidence: 45%

“…The incidence of constipation was 30.1% in the MDPT group and 26.9% in the TERP group. Many studies have reported lower rates of constipation following TERP [13,14]. A similar constipation rate of 30% has been described following the Duhamel procedure in a follow-up among adults [18].…”

Section: Bowel Functionmentioning

confidence: 62%

“…Despite many studies showing better immediate postoperative results [5][6][7][8], other studies have demonstrated similar or poorer outcomes concerning bowel function in the long term [9][10][11][12]. There are few systematic reviews and meta-analyses of long-term comparative data in the present literature with no uniform consensus [13][14][15].…”

Section: Introductionmentioning

confidence: 87%

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Modified Duhamel pull-through vs. Trans-anal endorectal pull-through in children with Hirschsprung's disease: Outcome comparison from a single center over 14 years

Shankar

Umashankar

Jadhav

et al. 2023

Preprint

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Purpose To analyze and compare short-term results and long-term bowel function in patients with Hirschsprung disease (HD) following two commonly performed definitive surgeries at our institute: Modified Duhamel pull-through (MDPT) and transanal endorectal pull-through (TERP).Methods 103 cases of HSD who underwent pull-through procedures (MDPT, n = 71; TERP, n = 32) between 2007 and 2021 were included. Seventy-nine were assessed for bowel function by Rintala scoring (MDPT, n = 53; TERP, n = 26).Results The MDPT group had more early complications (40.84% MDPT vs. 25% TERP), including anastomotic leak (4.2%, n = 71) and adhesive intestinal obstruction (5.6%, n = 71). Rectal mucosal prolapse (3.1%, n = 32) and anal stricture (3.1%, n = 32) were noted exclusively following the TERP. Both groups had a similar incidence of HAEC (21% in MDPT vs. 20% in TERP). TERP group had more daily bowel movements post-pull-through (71.8% vs. 22.5% in MDPT). Bowel function was considered impaired, with Rintala score of < 17 in 61.5% of cases of TERP (vs. 16.9% of cases of MDPT, n = 53; P = 0.001).Conclusion In our institute, we found better bowel function outcomes following MDPT compared to TERP, with higher incidence of soiling and accidents following TERP. However, long-term outcomes following technical changes in performing the TERP procedure remains to be assessed.

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Section: Haeccontrasting

confidence: 45%

Section: Bowel Functionmentioning

confidence: 62%

Section: Introductionmentioning

confidence: 87%

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Modified Duhamel pull-through vs. Trans-anal endorectal pull-through in children with Hirschsprung's disease: Outcome comparison from a single center over 14 years

Shankar

Umashankar

Jadhav

et al. 2023

Preprint

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“…In multivariate analyses, the following covariates were included: length of aganglionosis (short vs long segment disease, in which long segment disease was defined as aganglionosis, extending proximal to the sigmoid including total colonic aganglionosis), operation technique (for each operation technique that was observed at least 10 times in our sample), and the presence of a temporary stoma. This variable selection was based on prior evidence that suggests differences in functional outcome between patients with rectosigmoid disease compared with long-segment disease, and studies suggesting differences in surgical and functional outcome after various operation techniques (27,28). A sensitivity analysis on the relation between age at surgery and the risk of a permanent stoma was separately done in patients without intellectual disability, to assess the bias of patients who received a permanent stoma because of intellectual disability, who may have limited possibilities for bowel management with irrigations.…”

Section: Methodsmentioning

confidence: 99%

Did Age at Surgery Influence Outcome in Patients With Hirschsprung Disease? A Nationwide Cohort Study in the Netherlands

Roorda

Verkuijl

Derikx

et al. 2022

Journal of Pediatric Gastroenterology &Amp; Nutrition

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Objectives: Hirschsprung disease (HD) requires surgical resection of affected bowel, but the current evidence is inconclusive regarding the optimal age for resection. The aim of this study was to assess whether age at resection of the aganglionic segment is a determinant for surgical outcomes. Methods: A cross-sectional cohort study was done including all consecutive patients with HD between 1957 and 2015, aged 8 years or older (n = 830), who were treated in 1 of the 6 pediatric surgical centers in the Netherlands. Outcome measures were mortality, postoperative complications, stoma rate and redo surgery rate, retrieved from the medical records. Additionally, constipation and fecal incontinence rate in long term were assessed with the Defecation and Continence Questionnaire (DeFeC and P-DeFeC). Results:The medical records of 830 patients were reviewed, and 346 of the 619 eligible patients responded to the follow-up questionnaires (56%). There was a small increase in the risk of a permanent stoma [odds ratio (OR) 1.01 (95% confidence interval {CI}: 1.00-1.02); P = 0.019] and a temporary stoma [OR 1.01 (95% CI: 1.00-1.01); P = 0.022] with increasing age at surgery, regardless of the length of the aganglionic segment and operation technique. Both adjusted and unadjusted for operation technique, length of disease, and temporary stoma, age at surgery was not associated with the probability and the severity of constipation and fecal incontinence in long term. Conclusions: In this study, we found no evidence that the age at surgery influences surgical outcomes, thus no optimal timing for surgery for HD could be determined.

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“…32,[40][41][42][43][44][45][46][47] Outcomes after Hirschsprungs PT may depend on surgical and pathological expertise, as well as perioperative care, and therefore, may be related to surgeon or hospital experience. [48][49][50] We aimed to determine whether surgeon or hospital-level HD operative volumes are associated with surgical outcomes following pullthrough in infants with HD.…”

Section: Introductionmentioning

confidence: 99%

Relationships Between Hospital and Surgeon Operative Volumes and Surgical Outcomes in Hirschsprung's Disease

Apfeld

Wood

Halleran

et al. 2021

Journal of Surgical Research

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Duhamel and Transanal Endorectal Pull-throughs for Hirschsprung' Disease: A Systematic Review and Meta-analysis

Cited by 33 publications

References 28 publications

Modified Duhamel pull-through vs. Trans-anal endorectal pull-through in children with Hirschsprung's disease: Outcome comparison from a single center over 14 years

Modified Duhamel pull-through vs. Trans-anal endorectal pull-through in children with Hirschsprung's disease: Outcome comparison from a single center over 14 years

Did Age at Surgery Influence Outcome in Patients With Hirschsprung Disease? A Nationwide Cohort Study in the Netherlands

Relationships Between Hospital and Surgeon Operative Volumes and Surgical Outcomes in Hirschsprung's Disease

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