Stooling and manometric findings after primary pull-throughs in Hirschsprung's disease: Perineal versus abdominal approaches.
OBJECTIVE
Primary pull-through via a perineal approach (PA) has recently been reported for Hirschsprung's disease. One criticism of this approach is that it requires a large amount of retraction on the anal sphincters. Additionally, because the procedure is new, most patients undergoing a PA are too young to assess long-term continence rates. This study examined early stooling patterns, anal sphincteric pressures, and number of enterocolitic episodes in infants who underwent a PA. Results were compared with a conventional combined transabdominal and perineal approach (TA).


METHODS
Over 2 years, 26 pull-through procedures were performed. Nine of those were PA, and 17 were TA. Twelve of the 26 patients had formal manometric studies postoperatively. Results are expressed as mean +/- SD; unpaired t test and Chi;(2) were used for statistical analysis.


RESULTS
Mean follow-up post-pull-through was 23 +/- 2.3 months for the TA and 14 +/- 1.9 months for the PA. Manometric resting sphincter pressure in the TA group averaged 79 +/- 17 mm Hg compared with 76 +/- 21 mm Hg in the PA group (P =.78). Number of stools per day was 3.3 +/- 0.6 in the TA group compared with 2.2 +/- 0.3 in the PA group (P =.17). Post-pull-through enterocolitis was experienced by 53% of the TA group (mean, 1.5 +/- 0.6 episodes) and 56% of the PA group (mean 0.9 +/- 0.4 episodes) for a P =.08 by Chi;(2) analysis.


CONCLUSIONS
Manometric sphincter pressure and enterocolitic episodes after a PA for Hirschsprung's disease appear to be similar to results obtained with a conventional TA. Evaluation of early stooling frequency shows a comparable frequency after a PA. This suggests that both methods are safe, and the PA does not appear to compromise sphincter integrity.
Section of Pediatric Surgery, Division of Gastroenterology, Department of Surgery, the University of Michigan Medical Center, Ann Arbor, MI, USA.
Kathleen
K
Van Leeuwen
James D
JD
Geiger
Jeffrey L
JL
Barnett
Arnold G
AG
Coran
Daniel H
DH
Teitelbaum
D001003:Anal Canal / Q000503:physiopathology / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D003672:Defecation; D013505:Digestive System Surgical Procedures / Q000379:methods*; D004760:Enterocolitis / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006627:Hirschsprung Disease / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008365:Manometry; D012007:Rectum / Q000503:physiopathology; D012189:Retrospective Studies