One-Stage Transanal Endorectal Pull-through for Treatment of Hirschsprung’s Disease in Adolescents and Adults

Abstract

These findings indicate that one-stage transanal endorectal pull-through operation in adolescent and adults is feasible and safe.

An Updated “Historical” Algorithm for Hirschsprung Pa-tients Who Present Late or Severely Ill

“…Contrary to a recent article advocating primary transanal endorectal pull-through for adolescents and adults who present late [10], we believe children who present outside the newborn period are not candidates for a primary pull-through because of the marked distension of their bowel. In the study by Ammar et al [10], the adolescents and adults may constitute a different patient population with a different disease severity. Following only 2 days of rectal irrigations, a primary pull-through was performed using the transanal approach.…”

“…This implies that the aganglionic segment was quite short with limited proximal dilatation. Nevertheless, the high rate of incomplete incontinence in the form of soiling (26.6%) in their series [10] is concerning and quite different from our experience. Excessive retraction on the anal sphincters to accommodate dilated bowel can lead to incontinence, and we avoid that.…”

Hirschsprung’s Disease in Adult Treated by Coloprotectomy and Colo-Anal Anastomosis

“…The surgical procedures developed to treat the disease in children have been applied to adults, Many procedures were reported in the littérature : Swenson abdominoperineal pull-through, Duhamel retrorectal pull-through, Soave endorectal pull-through, Lynn myectomy, LAR combined with myectomy, LAR with colectomy (State procedure). In our case we have use a coloprotectomy with a coloanal anastomosis [2,[12][13][14][15].…”

“…Lynn procedure for posterior anorectal myectomy was advocated its usefulness as an initial approach or complementary procedure approach to short segment Hirschsprung's disease because of the low morbidity and absence of technical difficulty. The long-term results of a combination of anorectal myectomy and anterior resection showed excellent results with no major complications [13,14,17,18].…”

Hirschsprung Disease beyond Infancy

“…For that reason, we prefer a conservative approach to older patients by performing a laparoscopic-assisted leveling ostomy to determine the level of ganglionated colon and a concomitant resection of the dilated distal segment down to the peritoneal reflection. However, others have successfully performed one-stage procedures 73 or other delayed anastomotic approaches with reasonable outcomes. 74 We have had occasion to perform a one-stage procedure if the colon dilation is minimal and the patient can be adequately prepped.…”