http://dx.doi.org/10.1016/j.jpedsurg.2010.02.087
scopus: 77953850972
Endorectal pull-through for Hirschsprung's disease-a multicenter, long-term comparison of results: transanal vs transabdominal approach
June 2010
Article
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Purpose: Previous studies have reported decreased continence in patients undergoing transanal endorectal pull-through (TERP) for Hirschsprung's disease compared to the older transabdominal approach (TAA). To address this, we examined long-term stooling outcomes in a large, multicenter cohort of patients undergoing either TERP or TAA. Methods: Data were collected from 5 large pediatric institutions. Patient families were surveyed using a stooling score system (0-40, best to worst total score). Inclusion criteria included patients older than 3 years and those who had more than 6 months of recovery after pull-through. Those with total colonic aganglionosis were excluded. Statistical analysis included univariate and multivariate linear regression (significance, P < .05). Results: Two hundred eighty-one patients underwent TERP (192) or TAA (89). Interviews were completed in 149 (104 [52%] TERP vs 45 [52%] TAA). The TAA group had a significantly greater number of daily bowel movements for each respective postoperative year and experienced more early complications (3% vs 1% with >1 complication; P = .061) and late complications (19% vs 4% with >1 complication; P < .001). Although the TAA group had a higher mean enterocolitis score (3.3 ± 0.4 vs 1.8 ± 0.2; P < .001), this was not borne out by multivariate regression analysis (P = .276). Parental survey showed that there were no significant differences between procedures in mean total, continence, or stooling pattern scores. Conclusion: Transanal endorectal pull-through was associated with fewer complications and fewer episodes of enterocolitis. In contrast to prior studies, TERP patients did not have a higher rate of incontinence. These results support use of TERP as an excellent surgical approach for children with Hirschsprung's disease
- article
- female
- human
- male
- disease severity
- follow up
- major clinical study
- priority journal
- controlled study
- clinical trial
- controlled clinical trial
- child
- intermethod comparison
- school child
- multicenter study
- outcome assessment
- preschool child
- decompression surgery
- convalescence
- hernia
- stenosis
- fever
- postoperative complication
- scoring system
- laparotomy
- repeat procedure
- postoperative infection
- wound dehiscence
- defecation
- antibiotic agent
- antibiotic therapy
- interview
- wound infection
- Continence
- Enterocolitis
- Hirschsprung disease
- Hirschsprung's disease
- Pull-through
- abdominal distension
- anastomosis stenosis
- Stooling
- anus continence
- anus surgery
- colon obstruction
- colon aganglionosis
- enterocolitis
- feces analysis
- feces
- feces impaction
- incontinence
- muscle resection
- pull through operation
- sphincterotomy
- surgical approach
