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Author Affiliations: Department of Pediatric Surgery, First Hospital Affiliated to Zhengzhou University, Zhengzhou 450052, China (Dahal GR, Wang JX, Guo LH )
Corresponding Author: Jia-Xiang Wang, PhD, Department of Pediatric Surgery, First Hospital Affiliated to Zhengzhou University, Zhengzhou 450052, China (Tel: 86-371-66913510; Fax: 86-371-66913510; Email: wjiaxiang@zzu.edu.cn)
Background: Single-stage transanal endorectal pull-through (TEPT) is a new technique for surgery of Hirschsprung's disease (HD). TEPT can be assisted by laparoscopy (laparoscopic assisted transanal pull-through, LATP) or with non-additional procedure (total transanal endorectal pull-through, TTEP). This study was undertaken to evaluate the long-term outcome of these approaches in children with HD.
Methods: We retrospectively studied 131 patients (112 males and 19 females) aged 7 days to 14 years who underwent single-stage TEPT from October 2003 to July 2008. The medical records were reviewed for pre-, intra- and immediate post-operative complications. The data on stool pattern and complications were collected during the follow-up. Outcome was measured by continence evaluation score.
Results: No patients had intraoperative complications, but 5 had minor immediate postoperative complications. Late postoperative complications in 12 patients included enterocolitis (4 patients, one with severe enterocolitis died 7 months after operation), soiling (6) and constipation (2). There was a significantly higher frequency of stool in patients aged more than 36 months and those with a resected colon more than 30 cm (P<0.05). LATP showed significantly higher frequency of stool and soiling (P<0.05). Of the 54 patients who were older than 3 years at the time of follow-up, continence score was normal in 10, good in 39, fair in 3, and poor in 2. Seventy-seven patients achieved good bowel control in 12.8¡À8.1 months after operation, 93.5% of whom within 24 months. Stool function was not improved in patients more than 30 months old after operation.
Conclusions: The long-term outcome of single stage TEPT was excellent. There were few postoperative complications, and stool pattern improved gradually to an excellent level within 24 months. Internal plication can be a good option for reducing the dilated proximal colon.
Key words: Hirschsprung's disease; internal plication; laparoscopic assisted transanal pull-through; postoperative outcome; total transanal endorectal pull through; transanal endorectal pull-through
World J Pediatr 2011;7(1):65-69
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