Transanal one-stage endorectal pull-through for Hirschsprung’s disease: a comparison with the staged procedures

Abstract

Transanal one-stage endorectal pull-through (TOSEPT) has been presented as the most recent progression in treatment of Hirschsprung's disease (HD), which may be able to replace various previous techniques. This prospective study was designed to compare the efficacy and probable complications of the commonly used open surgery with those of TOSEPT technique in management of HD. Forty-two children (35 boys and 7 girls) between 3 days and 12 years of age underwent surgical treatment for HD-all after being diagnosed by barium enema over an 18-month period. In a manner of systematic random selection, 21 patients were operated by TOSEPT and the other 21 by Swenson procedures. All patients were followed-up at least for 12 months after hospital discharge. The necessary data containing age, sex, length of the resected aganglionic segment, intraoperative details, duration of hospital stay and postoperative functional results or complications were collected during hospitalization and follow-up period. There was no significant difference in age at the first operation, sex distribution and length of resected bowel between the two groups. Rate of postoperative complications were significantly higher in Swenson procedure group (P < 0.01). Narcotics were needed in all patients of Swenson procedure group but only in two patients operated by TOSEPT also required laparotomy (P < 0.001). The hospitalization period of TOSEPT group was also less than that of Swenson group (P < 0.001). The total cost of treatment by Swenson procedure is considerably higher than by TOSEPT. TOSEPT can significantly diminish postoperative pain, surgical complications, hospital stay and cost burden caused by Hirschsprung's disease. Besides, this procedure is cosmetically preferable because no visible scar remains.

Outcome of transanal endorectal vs. transabdominal pull-through in patients with Hirschsprung’s disease

“…However, the possible effects of transanal mobilization of rectum and colon on the anal sphincters, have caused considerable concern about long-term anorectal function, particularly soiling, constipation, and incontinence. Only a few studies have compared traditional transabdominal pull-through techniques with the more recently developed TERPT procedure [2][3][4][5][6][7]. The aim of the present study, therefore, was to compare postoperative complications and long-term outcome in 53 patients in whom a TERPT or transabdominal (ABD) pull-through procedure was carried out.…”

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 …”

“…(De la Torre & Ortega, 2000;Gao et al, 2001;van Leeuwen et al, 2002;Rintala, 2003;Minford et al, 2004;Elhalaby et al, 2004;Sapin et al, 2006;Li et al, 2006;Aslan et al, 2007;Podevin et al, 2007;Ishikawa et al, 2008;Aslanabadi et al, 2008;El-Sawaf et al, 2007;Tannuri et al, 2009;Obermayr et al, 2009).…”

“…2009 Leeuwen et al, 2002;Shankar et al, 2002;Rintala, 2003;Hadidi, 2003;Langer et al, 2003;Juliá et al, 2004;Minford et al, 2004;Elhalaby et al, 2004;Li et al 2006;Sapin et al, 2006;Paul et al, 2007;Jester et al, 2009;Obermayr et al, 2009;Tannuri et al,. 2009) Por outro lado, alguns autores referem que em seus pacientes esta complicação não foi observada (Liu et al, 2000;Teeraratkul, 2003;Wester & Rintala, 2004;Nasr & Langer, 2007;Aslanabadi et al,2008) Em nossa casuística o toque retal foi realizado em todos os pacientes entre 14º ao 30º dia de pós-operatório (média de 16,2 dias). Todas estas crianças demonstraram presença de reflexo retoesfincteriano.…”