F. Obermayr P. Szavay R. Beschorner J. Fuchs Outcome of transanal endorectal pull-through in patients with Hirschsprung's disease Eur J Pediatr Surg 19/4 2009 (August) 220 223

Abstract

Various outcomes after transanal endorectal pull-through (TERPT) in patients with Hirschsprung disease have been reported. In this study, the postoperative course and functional outcome after TERPT in 25 patients with Hirschsprung disease are evaluated. Age at operation, sex, associated malformations, length of follow-up, presence of colostomy, indication for laparotomy, length of the aganglionic segment, results of rectal examination under general anesthesia 6 weeks after surgery, and necessity of a dilatation program or reoperation were evaluated. In addition, the following data were collected: bowel movements per day, fecal continence, incidence of diarrhea, and the necessity for laxants. Median age at surgery was 3.5 months. Median follow-up was 35 months. Calibration of the anus showed a normal age-related diameter in 12 of 20 children and a markedly reduced diameter in 8 of 20 children 6 weeks postoperatively. Seven of the latter children underwent a dilatation program. A redo pull-through procedure had to be carried out in 3 patients because of stenosis at the coloanal anastomosis (n = 1), constricting muscle cuff (n = 1), and a twisted pull-through (n = 1). Two children developed enterocolitis. The median frequency of bowel movements was 3/d. Laxative treatment was required in only 1 patient (4.5%). None of the patients had diarrhea. Eighteen children were continent (95%). One patient (5%) with trisomy 21 suffered from intermittent nonretentive fecal incontinence. None of the patients showed signs of bladder dysfunction. It is concluded that functional outcome in most patients after TERPT is satisfactory. The authors suggest that routine rectal digital examination and anal calibration under anesthesia 6 weeks postoperatively might detect occult stenoses and allow early initiation of therapeutic measures, which could decrease the incidence of enterocolitis, persistent constipation, and the necessity for further surgical interventions.