Results of Transanal Endorrectal Descent in Hirschprung's Disease

Abstract

ObjectiveTo present our experience of patients with Hirschsprung disease (HD) operated by transanal endorrectal descent (TED). MethodsA retrospective study performed of TEDs. We correlate fundamentally the aganglionic segment length with: complications, need for colostomy and surgical approach. ResultsBetween 2003 and 2012 we performed 73 TED (57 men), 78.6% diagnosed in the neonatal period. The aganglionic segment length evidenced in the enema was correlated with surgical findings in 68.9% of cases, being higher in the short forms than in the long segments (80.9 vs 44%, P<.001). Four patients required preoperative colostomy. The mean age of surgery was 6.3 months (4.5–33.7). Short forms represented 64.4% of cases. The abdominal approach was necessary in 10 patients, nine of these were long/total colonic aganglionic segment. Postoperative enterocolitis presented in 10.9% (nine patients), with no relation with the length of aganglionic or the existence of residual dysplasia. Obstructions occurred in 19.2% of the long form or pancolonic forms. Currently, of the evaluable patients, five present constipation and 12 present occasional leakage. ConclusionsTED is the surgery of choice for patients with HD. The majority can be handled by preoperative “nursing” without colostomy. The diagnostic tests of choice are manometry with suction biopsy. No significant correlation was found between enterocolitis and length of aganglionic segment, although we observed a drastic reduction of postoperative enterocolitis, since the introduction of technical changes, such as the use of postoperative rectal tubes and the posterior section of the cuff muscles.