Transanal versus open endorectal pull-through for Hirschsprung's disease.
OBJECTIVE
Transanal endorectal resection and pull-through technique (TERPT) for Hirschsprung's disease (HD) was described in 1998. It offers the advantages of avoiding laparotomy, laparoscopy, scars, abdominal contamination, and adhesions. The authors compared TERPT with 2 open standard endorectal pull-through approaches.


METHODS
Twenty-eight HD patients operated on by endorectal pull-through were compared in 3 groups. Group I had 10 patients with preliminary colostomy approached by laparotomy; group II, 8 by laparotomy; and group III, 10 patients treated by TERPT. Age, operating time and bleeding, complications, follow-up, and functional results were analyzed. Mean, standard deviation, and median were calculated. Groups were compared by 1-way analysis of variance (ANOVA) using the Kruskal-Wallis test.


RESULTS
Age and length of follow-up were not statistically different (P = .12 and .07, respectively). Operating time and bleeding were less in group III (P = .03 for both). An intestinal obstruction secondary to adhesions and a subhepatic abscess occurred in group I and II, respectively. Minimal complications occurred in group III. Good functional results were obtained in 80% to 90% of the patients in all groups.


CONCLUSIONS
TERPT minimizes blood loss in this study, was expeditious, uncomplicated, and as effective as the open standard techniques.
De la Torre
L
L
Department of Surgery, Instituto Nacional de Pediatría, Mexico City, México.
Ortega
A
A
D001003:Anal Canal / Q000601:surgery*; D000704:Analysis of Variance; D002675:Child, Preschool; D003107:Colorectal Surgery / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006627:Hirschsprung Disease / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D007223:Infant; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D011336:Probability; D012007:Rectum / Q000601:surgery; D012189:Retrospective Studies