Modified transanal rectosigmoidectomy for hirschsprung’s disease: clinical and manometric results in the initial 20 cases

Peterlini, Fábio Luís; Martins, José Luiz

doi:10.1016/s0022-3468(03)00189-1

Cited by 16 publications

(15 citation statements)

References 7 publications

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“…As for the defecation function after radical surgery with a conventional laparotomy, it has often been reported that the incidence of constipation or fecal incontinence is not always satisfactory [7][8][9]. Conversely, it has often been reported that the defecation function after TA-EPT is good [10][11][12][13], and it was also generally observed not to be problematic in our study results. Regarding tests to verify the clinical evaluation, there have been some reports of studies with anorectal pressure such as the resting anal pressure and the anorectal reflex [12,14,15], but there have been very few reports regarding colonic motility during defecation.…”

Section: Discussionsupporting

confidence: 68%

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

et al. 2007

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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.

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Section: Discussionsupporting

confidence: 68%

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

et al. 2007

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“…The resection level of the aganglionic segment was established with the aid of biopsies to enable anatomopathological identification of the transition cone, by means of frozen section examination. The coloanal anastomosis was constructed in accordance with the principles proposed by Swenson 1 . None of these patients underwent colostomy.…”

Section: Group 2 (N = 19)mentioning

confidence: 99%

Clinical, manometric and profilometric evaluation after surgery for Hirschsprung's disease: comparison between the modified Duhamel and the transanal rectosigmoidectomy techniques

et al. 2009

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PURPOSE: To evaluate fecal continence, anorectal manometry (AM) and profilometry (P), in patients operated for congenital megacolon, using either the modified Duhamel technique (MDT) or the modified transanal rectosigmoidectomy (MTR) technique. METHODS: 42 patients were evaluated clinically and via AM and P, for postoperative control. The resting, coughing, voluntary contraction, maintained voluntary contraction and perianal stimulation pressures were investigated. The rectosphincteric reflex was tested and the simple and enhanced pressure curves were evaluated. The three-dimensional profilometric outline was produced. Student's t, chi-squared and Fisher's exact tests were used for statistical analysis (p<0.05). RESULTS: AM showed mean resting pressures of 53.44 mmHg for MDT and 60.67 mmHg for MTR, and mean voluntary contraction pressures of 94.50 mmHg for MDT and 95.47 mmHg for MTR. There was no statistical difference between the groups. The shapes of the simple and enhanced pressure curves did not present any statistical difference, independent of the surgical technique used. CONCLUSION: The two surgical techniques were equivalent. MDT caused greater incidence of postoperative constipation that MTR did. AM and P were shown to be excellent tests for postoperative follow-up among these patients.

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“…Most of them have been reported not to be related directly to the HD or its surgical treatment. In some published series, it is not clear, whether all children with TAP are alive or not, or there are some patients who were lost to follow-up [10,12,13]. Similar to the large series in the literature, three of the deaths of our patients had no evidence of EC or other problems associated with HD.…”

Section: Discussionmentioning

confidence: 48%

“…Since the first description by De la Torre and Ortega [5], the transanal endorectal pull-through became a popular operation worldwide for HD [2,4,21]. Many pediatric surgeons perform a submucosal dissection (Soave type), whereas some others prefer Swenson type transanal surgery [12,15]. Whatever the surgical technique, the one-stage transanal operations provide minimal postoperative complications, less pain, early discharge from hospital, less bleeding, minimal risk of adhesion, lowered risk of injury to pelvic structures and a far superior cosmetic result.…”

Section: Discussionmentioning

confidence: 99%

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Is there a hidden mortality after one-stage transanal endorectal pull-through for patients with Hirschsprung’s disease?

et al. 2006

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One-stage transanal pull-through (TAP) has become a standard definitive procedure for the treatment of Hirschsprung's disease (HD). Short-term results of this operation seem to be excellent, but long-term outcome is still obscure. We evaluated the morbidity and mortality of our patients with one-stage TAP, and we reviewed the literature. We performed a TAP without a colostomy in 21 patients with HD. The primary outcome measures are age, sex, complications during surgery, enterocolitis (EC) attacks after surgery, postoperative stooling problems and mortality. All patients were called over telephone, and their clinical and functional outcomes were obtained. Case series of TAP in the literature were also reviewed in terms of postoperative problems. Twenty-one patients with full thickness rectal biopsy-proven HD underwent one-stage TAP. Average follow-up was 28 months. One early postoperative EC and three more late attacks of EC were observed. All survived patients had normal bowel habits. Three patients had perianal excoriations, three patients soiling, seven cases required anal dilatations and four patients experienced a diarrhea after surgery. We have been informed that four patients died after discharge from hospital. Two of them were a sudden death (one patient had metabolic problems, the other might have had an EC attack). The cause of death of one patient with an associated Down syndrome was a severe pneumonia, and one other case died of a septic shock of unknown etiology. None of these patients had a diarrhea or abdominal distention, which could have been an evidence of an EC attack prior to their deaths. We observed similar fatal cases, when reviewed the published series in the literature. There might be a hidden mortality within the long-term period after TAP for HD. Therefore, we recommend a close follow-up for all patients with any associated health problem and those from low socioeconomic regions after one-stage pull-through.

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Modified transanal rectosigmoidectomy for hirschsprung’s disease: clinical and manometric results in the initial 20 cases

Cited by 16 publications

References 7 publications

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

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

Clinical, manometric and profilometric evaluation after surgery for Hirschsprung's disease: comparison between the modified Duhamel and the transanal rectosigmoidectomy techniques

Is there a hidden mortality after one-stage transanal endorectal pull-through for patients with Hirschsprung’s disease?

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