Results of one Stage Transanal Resection of Large Bowel in Hirschsprung's Disease

Document Type : Research Paper

Authors

1 Associate Professor of Pediatric Surgery Dr. Sheikh Pediatric Hospital, Mashhad University of Medical Sciences, Mashhad, Iran

2 Associate Professor of Pathology, Dr. Sheikh Pediatric Hospital, Mashhad University of Medical Sciences, Mashhad, Iran

3 Assistant Professor of Anesthesiology, Dr. Sheikh Pediatric Hospital,Mashhad University of Medical Sciences, Mashhad, Iran

4 Resident of Surgery, Emam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran

5 General practitioner, Dr. Sheikh Pediatric Hospital, Mashhad University of Medical Sciences, Mashhad, Iran

Abstract

Introduction
Hirschsprung's disease is a developmental disorder of the enteric nervous system, characterized by functional obstruction. Absence of ganglion cells in the distal colon resulting in a functional obstruction. The aim of this study was to evaluate the results and complications of one-stage transanal endorectal pull-through (OTEPT) in the management of patients with Hirschsprung's disease.
Materials and Methods
A total of 40 children (31 boys and 9 girls) aged 3 days to 60 months underwent OTEPT procedure over a period of two-years at Dr. Sheikh pediatric Hospital. This study was approved by the local committee of Medical Ethics. Median follow up period was 9.10 months (range, 3 to 33 months).
Results
Mean operation time recorded 101.60 mins (range, 25 to 270 minutes). Hirschsprung's disease developed conventional in 55% (short segment in 30%), Ultra-short in 32.5% and long segment in 12.5%. Mean length of resected bowel measured 17.31 cm, 2 patients underwent laparatomy because of extension of aganglionic segment beyond the sigmoid colon. Mean NPO time and need to rectal tube after the operation were 4.35 and 4.41 days, respectively. 8 patients required urinary catheters after the operation with the mean remaining time of 3.30 days, 20% needed ICU care after surgery and mean hospital stay was 5.76 days. Post-operative complications included entrocolitis (n=2) and abdominal distension (n=1). One patient expired due to non surgical reason (heart failure).
Conclusion
OTEPT procedure is a safe method with low incidence of postoperative complications. In Hirschsprung's disease confined to the rectosigmoid region, the hazard and morbidities associated with laparatomy and colostomy are avoided with this technique.

Keywords

References

1- Langer J. Colon (Hirschsprung’s disease). In: O’Neill. Pediatric surgery. 5th ed. Philadelphia: W B. Saunders
Company; 1998.p. 1347-1363.
2- Holschneider A, Ure B. Hirschsprung’s disease. In: Achcraft W, Holcomb G, Murphy P. Pediatric surgery. 4th ed.
Philadelphia: Elsevier-Inc; 2005.p. 477-491.
3- Pratap A, Shakya VC, Biswas BK, Sinha A, Tiwari A, et al. Single-stage transanal endorectal pull-through for
Hirschsprung's disease: perspective from a developing country. J Pediatr Surg 2007; 42:532-535.
4- Wilcox DT, Bruce J, Bowen J, Bianchi A. One-stage neonatal pull-through to treat Hirschsprung's disease. J Pediatr
Surg 1997; 32:243-5; discussion 245-7.
5- Elhalaby EA, Hashish A, Elbarbary MM, Soliman HA, et al. Transanal one-stage endorectal pull-through for
Hirschsprung's disease: a multicenter study. J Pediatr Surg. 2004; 39: 345-351.
6- Li AW, Zhang WT, Li FH, Cui XH, Duan XS. A new modification of transanal Soave pull-through procedure for
Hirschsprung's disease. Chin Med J (Engl) 2006; 119: 37-42.
7- Touk BA. Transanal one stage soave pull-through for Hirschsprugs disease. Saudi Med J 2003; 24:537-538.
8- Weidner BC, Waldhausen JH. Swenson revisited: A one-stage, transanal pull-through procedure for Hirschsprung's
disease. J Pediatr Surg 2003; 38:1208-1211.
9- Teeraratkul S. Transanal one-stage endorectal pull-through for Hirschsprung's disease in infants and children. J
Pediatr Surg 2003; 38:184-187.
10- Hadidi A. Transanal endorectal pull-through for Hirschsprung's disease: experience with 68 patients. J Pediatr Surg
2003; 38: 1337-1340.
11- Zhang SC, Bai YZ, Wang W, Wang WL. Clinical outcome in children after transanal 1-stage endorectal pullthrough
operation for Hirschsprung's disease. J Pediatr Surg 2005; 40:1307-1311.
12- Shayan K, Smith C, Langer JC. Reliability of intraoperative frozen sections in the management of Hirschsprung's
disease. J Pediatr Surg 2004; 39:1345-1348.
13- Albanese CT, Jennings RW, Smith B, Bratton B, Harrison MR. Perineal one-stage pull-through for Hirschsprung's
disease. J Pediatr Surg 1999; 34: 377-380.
14- Langer JC, Seifert M, Minkes RK. One-stage Soave pull-through for Hirschsprung's disease: a comparison of the
transanal and open approaches. J Pediatr Surg 2000; 35:820-822.
15- Weinberg M, Klin B, Vinograd I. One-stage surgery for Hirschsprung's disease in children. Harefuah 1999; 137:
269-271, 350.
16- Ramesh JC, Ramanujam TM, Yik YI, Goh DW. Management of Hirschsprung's disease with reference to one-stage
pull-through without colostomy. J Pediatr Surg 1999; 34:1691-1694. 
medical journal of mashhad university of medical sciences
Volume 51, Issue 4 - Serial Number 4
November and December 2008
Pages 219-224

Files

Share

How to cite

Statistics