Primary Neonatal Transanal Pull Through for Hirschprung’s Disease: Ten-Year Experience

Abstract

Transanal endorectal pull through (TEPT) is a minimally invasive technique for the surgical management of Hirschsprung’s disease. This study reviewed the early and late complications with this technique when utilized to neonates since 1999. Methods: The records of the author’s neonatal cases undergoing TEPT from 1999 to 2011 were reviewed for early and late complications. Early complications investigated were: anastomotic dehiscence, perianal excoriations, pelvic infection, wound infection and enterocolitis. Late complications included: anastomotic stricture, enterocolitis, retraction of pull through segment, rectal prolapsed, soiling and constipation. Results: Sixty-three patients were included in the study of which 54 were evaluable for long-term complications. The average weight of the patients was 3 kg (range 0.8 kg – 3.5 kg). Mean post-natal age was 16 days (range 6-28days). There were 39 males and 24 females. The rates of early complications were: Anastomotic dehiscences (1.59%), wound infection (1.59%), enterocolitis (9.52%). The late complications were: Anastomotic stricture (3.70%), enterocolitis (7.41%), retracted pull-through segment (18.52%), rectal prolapse (3.70%) and perianal excoriations (9.26%). In 26 patients, 4 years old and above, the rate of voluntary bowel movement was 80.76%. Three patients, initially, had constipation with soiling. Conclusion: TEPT, as a definitive surgery for neonates with Hirschsprung disease, provided acceptable early and late complication rates in the personal experience of the author comparable with the experience of surgeons from other institutions. The procedure provided the patients less number of operations and admissions, and lesser costs. Only 3 patients required abdominal incision. This will encourage us to continue utilizing the technique in newborns. Key words: transanal endorectal pull through, Hirschprung’s disease