OUTCOME OF ONE STAGE TRANSANAL ENDORECTAL PULLTHROUGH FOR MANGEMENT OF HIRSCHSPRUNG’S DISEASE

Abstract

Introduction: over the years, the surgical management of recto-sigmoid Hirschsprung’s disease (HD) has evolved
radically and at present a single stage transanal pull-through can be done in suitable cases, which obviates the need
for multiple surgeries and blood transfusion. The aim of this study was to test the outcome and safety of single stage
endorectal pull-through for management of (HD).
Material and methods: A retrospective analysis (between January 2007 to November 2008) was carried out on all
cases of Hirschsprung’s reporting to pediatric surgery unit ,Zagazig university hospital, that were managed by
transanal pull-through as a definitive treatment. All selected patient including neonate had an aganglionic segment
confined to the rectosigmoid area, confirmed by preoperative barium enema and postoperative pathology. All
children had their operation done without construction of prior colostomy .we relied on the level indicated on a
barium enema as well as clinical intra operative assessment since we lacking the facilities of frozen section .
Result: Transanal pull-through was performed in 14 children including 5 neonates. Mean operative time was 100
minutes (range 64 to 135 minutes). And mean hospital stay was 3-5 days. Oral feeding started 24-48 hours
postoperatively. No patient required laparotomy because all patients including neonates had an aganglionic segment
confined to the rectosigmoid area. Blood loss ranged between 20 to 85 ml with blood replacement required in 2
cases. Since all children were given an epidural caudal block, the requirement of analgesia in these cases was
minimal. postoperative complications included perianal excoriation in 11 out of 14 (78%)patients lasting from 3
weeks to 6 months, which included all neonates (n=5). Complete anorectal continence was noted in 10 of 14 (71.3)
children in follow up of 2 years, whereas 3 other patients showed a steady improvement in their continence status.
Conclusion: one stage transanal endorectal pull-through for selected cases is easy, bloodless, without visible scar
and with short hospital stay. We believe that this procedure can be safely conducted based on the clinical experience
which all pediatric surgeons possess since they regularly perform leveling colostomies in Hirschsprung disease.
Key words: single stage, transanal, pull-through procedure, Hirschsprung’s disease, frozen section biopsy, perianal
excoriations.