Abstract
Objective The aim of the study is to appraise bowel movements in children with Hirschsprung's disease (HD) after a transanal Soave 1-stage endorectal pull-through (TAS) procedure. Methods From October 2000 to October 2004, 44 patients with HD underwent a TAS procedure, 35 had a Soave operation via a laparotomy, 29 underwent a Soave procedure via laparoscopy, and 39 had an Ikeda-Soper procedure; the patients were followed up from 1 to 5 years after surgery. Evaluation of the perioperative therapeutic effect and postoperative bowel movements between the 4 groups were analyzed by Kelly's score and anorectal manometry. Results The TAS procedure required less operative time and costs than the Soave procedure via laparotomy or laparoscopy ( P < .05) and less than that of Ikeda-Soper procedure for the duration of the preoperative preparation, the duration of the surgical procedure, intraoperative blood transfusions, days of postoperative fasting, antibiotic use, and days and cost of hospitalization ( P < .01). There were no differences in short-term and long-term complications between the same Soave procedures; the Soave procedure exceeded the Ikeda-Soper operation in the incidence of enterocolitis 3 months postoperatively ( P < .05), but there was no difference between the TAS procedure and the Ikeda-Soper procedure. There was no difference in bowel movements 12 months postoperatively and the rectal anal inhibitory reflex, high-pressure zone length, resting anal canal pressure, and the sensation threshold 1 year postoperatively between the TAS procedure and the Ikeda-Soper procedure, but the active contractile pressure was lower after the TAS procedure than the Ikeda-Soper procedure. Conclusions The TAS procedure is more suitable than the Soave operation via laparotomy or laparoscopy and Ikeda-Soper procedure and is feasible in infants with short segment type and common type HD.
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