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ISSN 1561-3119 (Electronic)

2012, Number 3

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Rev Cubana Pediatr 2012; 84 (3)

Clinical evolution of patients with Hirschsprung's disease operated on by transanal techniques

Hernández AHD, Vialat SV, Labrada AE, Navarro SAB

Language: Spanish
References: 21
Page: 216-224
PDF size: 59.56 Kb.


ABSTRACT

Introduction: the surgical treatment of Hirschsprung's disease has positively evolved since 1998 when De la Torre Mondragón described his totally transanal endorectal pull through technique. Nevertheless, these technical variants are relatively new and little has been said about the postoperative evolution and the continence status of the surgical patients.
Methods: an observational descriptive study of 43 surgical patients, who suffered Hirschsprung's disease and were operated on by transanal one-stage techniques from 2004 to 2011 at university pediatric hospital of Centro Havana, was carried out. All the patients were given a questionnaire to find out the condition of the intestinal and urinary functions at different times, six months after surgery. The results were correlated with age and length of the resected segment. Fisher's test was used for the statistical analysis, being p< 0,05.
Results: the average age at the time of operation was 3 years (range, 1 to 15 years) and males prevailed. The rectosigmoid variant was the most common, which was evidenced by the barium enema. All these cases underwent one-stage surgery; 38 patients were satisfactorily evaluated in terms of continence and just two cases presented with constipation. A significant association between longer resected segment and the presence of altered defecation pattern was found.
Conclusions: the intestinal function is satisfactory in most of patients operated on by transanal one-stage pull-through techniques for treating Hirschsprung's disease.


REFERENCES

  1. De La Torre-Mondragón L, Ortega-Salgado JA. Transanal endorrectal pull-through for Hirschsprung's disease. J Pediatr Surg. 1998;33:1283-6.

  2. Zhang SC, Wang WL, Bai YZ. Evaluation of anorectal function after transanal one-stage endorectal pull through operation in children with Hirschsprung's disease. Zhongguo Dang Dai Er Ke Za Zhi. 2007;9:188-92.

  3. El-Sawaf M, Drongowski RA, Chamberlain J, Coran A, Teitelbaum D. Are the long-term results of the transanal pull-through equal to those of the transabdominal pull-through? A comparison of the 2 approaches for Hirschsprung disease. J Pediatr Surg. 2007;42:41-7.

  4. Holschneider A, Steinwegs I. Functional diagnosis. In: Holschneider A, Puri P (eds.). Hirschsprung's Disease and Allied Disorders. 3rd ed. New York: Springer; 2008. p. 133-84.

  5. Aslan MK, Karaman I, Karaman A. Our experience with transanal endorectal pull-through in Hirschsprung's disease. Eur J Pediatr Surg. 2007;17:335-9.

  6. Nasr A, Langer JC. Evolution of the technique in the transanal pullthrough for Hirschsprung's disease: effect on outcome. J Pediatr Surg. 2007;42:36-40.

  7. Levitt MA, Martin CA, Olesevich M, Bauer CL, Jackson LE, Peña A. Hirschsprung's disease and fecal incontinence: diagnostic and management strategies. J Pediatr Surg. 2009;44:271-7.

  8. Ph¡m AV. Transanal one-stage endorectal pull-through for Hirschsprung's disease: experiences with 51 newborn patients Pediatr Surg Int. 2010;26:589-92.

  9. Teitelbaum DH, Cilley RE, Sherman NJ. A decade of experience with the primary pull-through for Hirschsprung disease in the newborn period: a multicenter analysis of outcomes. Ann Surg. 2000;232(3):372-80.

  10. Van Leeuwen K, Geiger JD, Barnett JL. Stooling and manometric findings after primary pull-through in Hirschsprung's disease: perineal versus abdominal approaches. J Pediatr Surg. 2002;37(9):1321-5.

  11. Podevin G, Lardy H, Azzis O. Technical problems and complications of a transanal pull-through for Hirschsprung's disease. Eur J Pediatr Surg. 2006;16:104-8.

  12. Pratap A, Guptab DK. Analysis of problems, complications, avoidance and management with transanal pull-through for Hirschsprung disease. Journal of Pediatric Surgery. 2007;42:1869-76.

  13. Kim AC, Langer JC, Pastor AC, Zhang L. Endorectal pull-through for Hirschsprung's disease. A multicenter, long-term comparison of results. Transanal vs. Transabdominal approach. Journal of Pediatric Surgery. 2010;34:1423-9.

  14. Curran TJ, Raffensperger JG. Laparoscopic Swenson pullthrough: a comparison with the open procedure. J Pediatr Surg. 1996;31:1155-7.

  15. Pierro A, Fassoli L, Kiely EM. Staged pull-through for rectosigmoid Hirschsprung's disease is not safer than primary Pullthrough. J Pediatr Surg. 1997;32:505-9.

  16. Jasonni J, Pini Prato A, Martucciello G. Soave's extramucosal endorectal pull-through procedure. In: Holschneider A, Puri P (eds). Hirschsprung's Disease and Allied Disorders. 3rd ed. New York: Springer; 2008. p. 337-48.

  17. Myrick C, Shinall Jr. A, Koehlerb E, Yu S, Harold N, Lovvorn I. Comparing cost and complications of primary and staged surgical repair of neonatally diagnosed Hirschsprung's disease. J Pediatr Surg. 2008;43:2220-5.

  18. Pratap A, Shakya VC, Biswas BK. Single-stage transanal endorectal pull-through for Hirschsprung's disease: perspective from a developing country. J Pediatr Surg. 2007;43:56-9.

  19. Till H, Heinrich M, Schuster T. Is the anorectal sphincter damaged during a transanal endorectal pullthrough (TERPT) for Hirschsprung's disease? A 3-dimensional, vector manometric investigation. Eur J Pediatr Surg. 2006;16:188-91.

  20. Zhang SC. Redo endorectal pull-through following various pull-through procedures in Hirschsprung's disease. Langenbecks Arch Surg. 2008;393:493-9.

  21. Gobran TA, Ezzat A, Hassan ME, O'Neill J. Redo transanal endorectal pull-through: a preliminary study. Pediatr Surg Int. 2007;23:189-93.




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