Is high amplitude propagated contraction present after transanal endorectal pull-through for Hirschsprung’s disease?

Abstract

The transanal endorectal pull-through (TAEPT) procedure is now widely performed for Hirschsprung's disease (HD), however, the colorectal function after TAEPT has not yet been adequately assessed. We evaluated the postoperative clinical outcome and colorectal function based on lower colonic manometry after TAEPT. Twenty-one cases of HD underwent TAEPT from 1998 to 2005. We examined the clinical outcome based on the requirement of enemas/suppositories, the number of defecations per day, the severity of perianal erosion, and the incidence of enterocolitis requiring hospital stay. Using a three-channel Dentsleeve catheter and UPS-2020 measuring device, we performed postoperative colonic manometry at three locations: (1) the anal canal, (2) 5 cm proximal to the anal canal, and (3) 10 cm proximal to the anal canal, during defecation, and then we measured the appearance of high-amplitude contraction (HAC) (duration >/=10 s, amplitude >/=100 cmH(2)O). Four of 21 cases were treated with enemas/suppositories no longer than 1 year. The number of defecations decreased gradually from 4 to 5 per day in the early postoperative period, reaching 2 to 3 per day about 1 year postoperatively. Perianal erosion was noted in 3 of 21 cases but it disappeared within three postoperative years. Two cases had enterocolitis. Lower colon manometry was performed in eight cases. Manometry during defecation was successfully monitored in six cases. HAC occurred in five of six cases (83.3%). The clinical outcomes after TAEPT were satisfactory in almost all cases. These good outcomes were possibly due to the occurrence of HAC during defecation, though HAC did not fill the definition of high amplitude propagated contractions (HAPCs). The occurrence of HAC after TAEPT might be caused by keeping any damage to the mesenteric ascending cholinergic nerve to a minimum during surgery. Further long-term observations are still required to make an adequate assessment of such cases.

Outcome of Transanal Endorectal Pull-through in Patients with Hirschsprung's Disease

“…Persistent constipation is known to be one of the most frequent complications after PT in HD and is also described after TERPT. The necessity for laxative therapy is described in 4 -19.5 % [7,13] postoperatively. If not associated with stenosis, residual aganglionosis or hypoganglionic transition zone, intestinal neuronal dysplasia or twisted PT, conservative management is usually eff ective and symptoms resolve with time [8,22] .…”

White paper on guidelines concerning enteric nervous system stem cell therapy for enteric neuropathies

“…Current treatment involves surgical removal of the aganglionic segment, but functional outcome is variable and many patients suffer life-long complications (Conway et al, 2007; Laughlin et al, 2012; Ludman et al, 2002; Pini Prato et al, 2008; Tsuji et al, 1999). This may reflect dysfunction of the so-called “normo-ganglionic” segment (Di Lorenzo et al, 2000; Kohno et al, 2007), abnormal anal sphincter function, retention of aganglionic distal bowel, or the sequelae of proctectomy. Enteric neuronal stem/progenitor cell (ENSC) transplantation provides a potential therapy to replace absent ganglia.…”

Abaixamento endoanal do colón no tratamento da moléstia de Hirschsprung

“…Para eliminar estas complicações a técnica original foi modificada, preconizando anastomose do cólon à região do esfíncter anal de forma oblíqua (Teiltelbaum & Coran, 2006 (So et al, 1985). (Langer et al, 2003;Hadidi, 2003;Elhalaby et al 2004;Li et al, 2006;Till et al, 2006;Khono et al, 2007;Aslanabadi et al, 2008;Obermayr et al, 2009, Jester et al, 2009 (Carneiro et al, 1992 (Teiltelbaum & Coran, 2003).…”

“…Em diferentes casuísticas de cirurgia pela via endoanal, a incidência de enterocolite no pós-operatório variou de 0 a 66,7% (Albanese et al, 1999;Liu et al, 2000;Gao et al, 2001;van Leeuwen et al, 2002;Hadidi, 2003;Rintala, 2003;Langer et al, 2003;Teeratkul, 2003;Elhalaby et al, 2004;Julia et al, 2004;Zhang et al, 2005;Sapin et al, 2006;Ates et al, 2007;Nasr & Langer, 2007;Paul et al, 2007;Khono et al, 2007;El-Sawaf et al, 2007;Aslan et al, 2007;Huang et al, 2008;Ishikawa et al, 2008;Aslanabadi et al, 2008 …”

“…Por outro lado, Khono et al (2007) canal anal e a superinsuflação do balão retal (Nagasaki et al, 1980;Holscheneider & Kraeft, 1981 …”