Functional outcome after operation for Hirschsprung disease--transanal vs transabdominal approach

J Pediatr Surg. 2010 Aug;45(8):1640-4. doi: 10.1016/j.jpedsurg.2010.02.065.

Abstract

Background: It has been hypothesized that the extensive transanal dissection in transanal endorectal pull-through (TEPT) for Hirschsprung disease (HD) can impair the anal sphincters in neonates and thereby cause incontinence. Theoretically, transabdominal endorectal pull-through might have less impact on the sphincters. The aim of this study was to compare functional outcome in HD patients operated with either TEPT or laparotomy-assisted endorectal pull-through (LEPT) with particular focus on soiling and fecal incontinence.

Patients and methods: Anorectal function in 52 children older than 3 years is reported. The patients were operated for HD with either TEPT (n = 28) or LEPT (n = 24) and followed prospectively. Functional outcome was recorded by standardized interviews. The Krickenbeck criteria were used to classify voluntary bowel movements, soiling, and constipation.

Results: The median age at follow-up was 5.7 years (3.1-13.2) for TEPT and 10.1 years (7.7-16.2) for LEPT. Twenty-nine patients reported soiling at final follow-up. There was no difference in the rate of soiling between children operated with TEPT (54%) or LEPT (58%). Constipation was reported in 11 children (TEPT, 25%; LEPT, 17%).

Conclusions: The functional outcome and in particular the rate of soiling did not differ between patients operated with LEPT or TEPT.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Anal Canal / surgery
  • Child
  • Child, Preschool
  • Colon / surgery
  • Constipation / diagnosis
  • Constipation / therapy
  • Defecation / physiology
  • Digestive System Surgical Procedures / methods*
  • Fecal Incontinence / diagnosis
  • Fecal Incontinence / therapy
  • Hirschsprung Disease / surgery*
  • Humans
  • Infant
  • Infant, Newborn
  • Laparotomy / methods
  • Longitudinal Studies
  • Postoperative Complications / diagnosis
  • Postoperative Complications / therapy
  • Rectum / surgery
  • Treatment Outcome