Transanal mucosectomy for endorectal pull-through in Hirschsprung’s disease: comparison of abdominal, extraanal and transanal approaches

Abstract

EPT with perineal approaches is less invasive and can provide a better clinical outcome than EPT with AB in terms of postoperative soiling. Compared with EA and TA, EA tended to develop stagnant enteritis or residual constipation.

Functional outcome after operation for Hirschsprung disease—transanal vs transabdominal approach

“…Interestingly, continence score was significantly poorer after TEPT when compared with LEPT. In a small retrospective series of 8 TEPT patients and 20 LEPT patients, there was no soiling in the TEPT group compared with 45% soiling after LEPT [2].…”

“…Long-term functional results after TEPT are sparsely documented [2,[6][7][8][9]. One study reports more incontinence after TEPT than after abdominal mobilization of rectum and colon [7], whereas others present equal or even better results after TEPT [2]. Postoperative anal manometry after TEPT has demonstrated results similar to preoperative values or controls, indicating that sphincter damage after a transanal procedure was unlikely [10,11].…”

“…In children with HD, incontinence is regarded as an iatrogenic complication; and correct surgical technique is important to minimize incontinence. Long-term functional results after TEPT are sparsely documented [2,[6][7][8][9]. One study reports more incontinence after TEPT than after abdominal mobilization of rectum and colon [7], whereas others present equal or even better results after TEPT [2].…”

“…It is well documented that 1-stage transanal endorectal pullthrough (TEPT) is a safe and efficient operation with early complication rates comparable to laparoscopic or laparotomy-assisted procedures [1][2][3][4][5]. However, the possible effects of transanal mobilization of rectum and colon on the anal sphincters, especially in neonates, have caused considerable concern about long-term anorectal function, particularly soiling and incontinence.…”

Laparoscopic-assisted pull-through operation for Hirschsprung’s disease: a systematic review and meta-analysis

“…Interestingly, a study by Stensrud et al, which used independent examiners, showed a higher rate of long-term complications than other reports [14]. Also, different scores to assess the long-term bowel function developed by various institutions makes comparison challenging [15]. Furthermore, the outcome of the Pediatr Surg Int bowel function could be influenced by the age of the patients; if a patient is less than 4 years of age, he may not be considered continent at the time of follow-up.…”