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

Continence, Enterocolitis, Hirschsprung disease, Hirschsprung's disease, Pull-through, Stooling, abdominal distension, anastomosis stenosis, antibiotic agent, antibiotic therapy, anus continence, anus surgery, article, child, clinical trial, colon aganglionosis, colon obstruction, controlled clinical trial, controlled study, convalescence, decompression surgery, defecation, disease severity, enterocolitis, feces, feces analysis, feces impaction, female, fever, follow up, hernia, human, incontinence, intermethod comparison, interview, laparotomy, major clinical study, male, multicenter study, muscle resection, outcome assessment, postoperative complication, postoperative infection, preschool child, priority journal, pull through operation, repeat procedure, school child, scoring system, sphincterotomy, stenosis, surgical approach, wound dehiscence, wound infection
dx.doi.org/10.1016/j.jpedsurg.2010.02.087, hdl.handle.net/1765/20332
Journal of Pediatric Surgery
Erasmus MC: University Medical Center Rotterdam

Kim, A.C, Langer, J.C, Pastor, A.C, Zhang, L, Sloots, C.E.J, Hamilton, N.A, … Teitelbaum, D.H. (2010). Endorectal pull-through for Hirschsprung's disease-a multicenter, long-term comparison of results: transanal vs transabdominal approach. Journal of Pediatric Surgery, 45(6), 1213–1220. doi:10.1016/j.jpedsurg.2010.02.087