Single Stage Transanal Pull-Through for Hirschsprung’s Disease in Neonates: Our Early Experience

Abstract

Objective: Hirschsprung’s disease is one of the common causes of intestinal obstruction in neonates. Transanal endorectal pull-through represents the latest development in the concept of the minimally invasive surgery for Hirschsprung’s disease. In this study, we present our early experience with single stage transanal pull through in neonates. Design: Retrospective study of neonates with single stage transanal pull-through done for Hirschsprung’s disease in our institute from January 2011 to January 2013. Material and Method: Five newborn boys who presented with Hirschsprung’s disease were studied. The selection criteria included radiological transition zone at rectosigmoid or mid-sigmoid region, weight more than 2 kg, no evidence of enterocolitis or sepsis and no associated major anomaly. Single stage transanal endorectal pull-through was done in these patients. The follow-up period ranged from 6 months to 2 years. Results: Five patients with a mean age of 26.4 days (range 15-45 days) and a mean weight of 2.6 Kg (range 2.2 to 3.7 Kg) underwent transanal endorectal pull through. The mean operating time was 68 min (range 60 to 120 min). The average intra-operative blood loss was 20 ml (range – 10 to 30 ml) and the average length of bowel resected was 12.8 cm (range – 10 to 18 cm). Post-operatively patients passed first stool between 2nd and 3rd day. Oral feeding was resumed on 5th to 6th post-operative day. The average post-operative duration of stay in hospital was 10 days. None of the patients had post-operative bleeding, urethral injury, anastomotic leak or retraction of anastomotic site. Three patients developed perianal excoriation and one patient had post-operative enterocolitis. No mortality occurred in the series. Conclusion: Advancement in pediatric anaesthesia, availability of pediatric surgical expertise, improvement in pre-operative and post-operative management and nursing care has made single stage transanal pull-through in neonates a feasible option. The early results are comparable to single stage or multistage surgery in older children.

Transanal Endorectal Pull-Through Procedure for patients with Hirschsprung`s Disease: A prospective study

“…The conventional three stages procedure of HD by Swenson, Duhamel, and Soave had been substituted in the last two decades by the one stage TEPT and starts to gain popularity among pediatric surgeons due to its feasibility and less complication with results equal if not better than the traditional three stage procedures (6).In our study TEPT was carried on 11 patients, their ages were ranging from 1 month to 12 years; with a mean of (33.7±43.4 months), which reflects a wide range of ages at the time of pullthrough which refers to the feasibility of TEPT during and beyond the neonatal period, a fact that was documented by other studies done by Langer et al (7), and Bahatial et al (8). In the present series the male: female ratio was 4.5:1 which is differs from Ortiz-Rubio et al( 9) who described a male: female ratio of 1.8 : 1 but it agrees with the general concept and Langer et al (7) who described a ratio of 4 : 1 .…”

Transanal pull-through for Hirschsprung disease in neonates: A single-center experience

“…This complication is more frequent for patients treated with TAPT during the neonatal period, according to a meta-analysis conducted by Westfal et al [14] which can be explained by increased susceptibility of newborns to infections. [15] This complication was neither reported in the study conducted by Bhatia et al [8] nor by Hassan et al [4] and reported in only one patient by Ali. [16] Post-operative enterocolitis is considered one of the main complications of patients with HD before and after definitive treatment.…”

“…A large number of pediatric surgeons preferred the singlestage procedure at an early age. [8] The primary TAPT for HD has the advantage of avoiding the colostomy and its related complications including its social stigma. The aim of our study was to evaluate the feasibility, safety, and outcomes of TAPT during the neonatal period.…”

“…This can be explained by the easier mucosal dissection during the neonatal period due to the presence of less adherent mucosa (no repeated episodes of enterocolitis), a less dilated colon above the aganglionic segment, that the mesentery and the colon are less substantial and easier to mobilize and that the blood vessels are easier to control. [4,8,13] The advances in anesthesia and perioperative care made TAPT for newborns safe and feasible. We had no anesthetic complications in our patients.…”

Comparison Outcome of Patients with Rectal Tube and Without Rectal Tube Post Swenson Like Pull-Through Transanal Procedure at RSUP Prof Dr. I G.N.G. Ngoerah

“…Anastomotic leaks or strictures and the development of postoperative bowel obstruction secondary to adhesions increase the relative risk and subsequent enterocolitis by approximately 3-fold. Long seromuscular cuffs and high coloanal anastomoses are associated with an increased risk of postoperative enterocolitis [46]. Perianal rash or skin excoriation is common after pull-through surgery, especially among children who have had a stoma before pull-through, long segment colon or total colonic aganglionosis, and patients who have undergone surgery as neonates [22].…”