Transanal pull-through procedure for Hirschsprung's disease

TY - JOUR

T1 - Transanal pull-through procedure for Hirschsprung's disease

T2 - a 5-year experience

AU - Jester, I

AU - Holland-Cunz, S

AU - Loff, S

AU - Hosie, S

AU - Reinshagen, K

AU - Wirth, H

AU - Ali, M

AU - Waag, K-L

PY - 2009/4

Y1 - 2009/4

N2 - BACKGROUND/PURPOSE: Transanal endorectal pull-through (TEPT) has become a widely used approach for the treatment of Hirschsprung's Disease. The technique is safe and, according to previous reports, it has a good clinical outcome. In this study our experience with TEPT in the early postoperative period is evaluated.METHODS: The clinical course of 34 children (28 boys and 6 girls) who underwent one-stage pull-through operation according to De la Torre for Hirschsprung's disease from January 2003 to December 2007 was reviewed. Their ages ranged from 2 months to 4 years. Complications occurring within the first four weeks after operation were analyzed.RESULTS: Eight of 34 children (24 %) had early complications in the form of dehiscences of the anastomosis. Two children (6 %) had symptomatic anastomotic dehiscences. One child had an almost full retraction of the colon that had to be pulled down and resutured. One child developed a retrorectal abscess three weeks postoperatively due to anastomotic leakage. The dehiscences of 6 children (18 %) were asymptomatic. These dehiscences were detected only with standardized routine examination. The dehiscences healed uneventfully after resuturing. Two other patients (6 %) developed an anastomotic stricture that could be treated with rectal dilatations. Four children (12 %) showed a single episode of postoperative enterocolitis.CONCLUSION: The rate of early clinical and particularly subclinical complications such as anastomotic dehiscences after TEPT is higher than previously estimated. Patients should be monitored carefully during the early postoperative period. Severe complications can only be avoided with a thorough examination. Early resuturing of dehiscences might be helpful to prevent hazardous sequelae.

AB - BACKGROUND/PURPOSE: Transanal endorectal pull-through (TEPT) has become a widely used approach for the treatment of Hirschsprung's Disease. The technique is safe and, according to previous reports, it has a good clinical outcome. In this study our experience with TEPT in the early postoperative period is evaluated.METHODS: The clinical course of 34 children (28 boys and 6 girls) who underwent one-stage pull-through operation according to De la Torre for Hirschsprung's disease from January 2003 to December 2007 was reviewed. Their ages ranged from 2 months to 4 years. Complications occurring within the first four weeks after operation were analyzed.RESULTS: Eight of 34 children (24 %) had early complications in the form of dehiscences of the anastomosis. Two children (6 %) had symptomatic anastomotic dehiscences. One child had an almost full retraction of the colon that had to be pulled down and resutured. One child developed a retrorectal abscess three weeks postoperatively due to anastomotic leakage. The dehiscences of 6 children (18 %) were asymptomatic. These dehiscences were detected only with standardized routine examination. The dehiscences healed uneventfully after resuturing. Two other patients (6 %) developed an anastomotic stricture that could be treated with rectal dilatations. Four children (12 %) showed a single episode of postoperative enterocolitis.CONCLUSION: The rate of early clinical and particularly subclinical complications such as anastomotic dehiscences after TEPT is higher than previously estimated. Patients should be monitored carefully during the early postoperative period. Severe complications can only be avoided with a thorough examination. Early resuturing of dehiscences might be helpful to prevent hazardous sequelae.

KW - Anal Canal

KW - Child, Preschool

KW - Colectomy

KW - Female

KW - Hirschsprung Disease

KW - Humans

KW - Infant

KW - Male

KW - Reoperation

KW - Retrospective Studies

KW - Surgical Wound Dehiscence

KW - Treatment Outcome

KW - Journal Article

U2 - 10.1055/s-2008-1039052

DO - 10.1055/s-2008-1039052

M3 - SCORING: Journal article

C2 - 19224432

VL - 19

SP - 68

EP - 71

JO - EUR J PEDIATR SURG

JF - EUR J PEDIATR SURG

SN - 0939-7248

IS - 2

ER -