Transanal endorectal pull-through for classic segment Hirschsprung's disease: With or without laparoscopic mobilization of the rectosigmoid?

Abstract

Postoperative and clinical outcomes are similar using the TERPT or L-TERPT to correct classic segment Hirschsprung's disease. Prevention of colonic torsion should be the prime concern during the TERPT procedure. L-TERPT requires laparoscopic equipment and takes more operation time, whereas TERPT leaves no visible scars. The positive relation between the larger length of resection and obstructive symptoms requires additional research.

Psychosexual Well-Being After Childhood Surgery for Anorectal Malformation or Hirschsprung's Disease

“…There has been a shift, however, in the preference of the operative technique for HD, i.e., from the Rehbein operation, performed in 76% of the patients, to the currently preferred transanal pull through. The transanal pull through, often with laparoscopy to mobilize the rectum [23,24], is less invasive and involves dissection closer to the colon and therefore minimizes damage to innervation of the pelvic floor and reproductive organs. Further studies are needed to determine if psychosexual well-being is indeed more favorable with the transanal pull through operation.…”

Bowel Function and Quality of Life After Transanal Endorectal Pull-through for Hirschsprung Disease

“…1 The surgical treatment involves removal of the aganglionic segment and anastomosis of the innervated proximal bowel to the anus. 2 Bowel dysfunction, particularly varying degrees of fecal incontinence, are observed after all operative techniques for HD, [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22] although direct comparison of outcomes between series is challenging due to substantial variations in the methods used for the assessment of bowel function, length of follow-up, and inclusion criteria. During the past decades, 1-stage transanal endorectal pull-through (TEPT) has become one of the most commonly performed operations for HD.…”

“…3,4,23 The procedure can be performed totally transanally or in combination with transabdominal colonic mobilization using laparotomy or laparoscopy. [3][4][5][6][7][8][9][23][24][25] However, it has been suggested that bowel mobilization and dissection through the anus has the potential to interfere with anal sphincter integrity and rectal sensation, 3,6,8 but controlled studies of the long-term outcomes after TEPT are lacking. It has also been established that significant impairment of fecal control negatively impacts on quality of life (QoL) and social problems, [26][27][28] and validated assessment of the long-term QoL among HD patients after TEPT is timely.…”

Enterocolitis in the evolution of an early diagnosed Hirschsprung disease - case report

“…Moreover, laparoscopic assisted pullthrough for the definitive treatment is known to be associated with faster recovery period and fewer perioperative complications, as it reduces the adhesion formation and offers the possibility of a better mobilization and dissection of the aganglionic colon [11,12].…”