title: One-stage transanal Soave pullthrough for Hirschsprung disease: a multicenter experience with 141 children.
abstract: BACKGROUND
  The surgical management of Hirschsprung's disease (HD) has evolved from the original 3-stage approach to the recent introduction of minimal-access single-stage techniques. We reviewed the early results of the transanal Soave pullthrough from 6 of the original centers to use it.
  
  
  METHODS
  The clinical course of all children with HD undergoing a 1-stage transanal Soave pullthrough between 1995 and 2002 were reviewed. Children with a preliminary stoma or total colonic disease were excluded.
  
  
  RESULTS
  There were 141 patients. Mean time between diagnosis and surgery was 32 days, and mean age at surgery was 146 days. Sixty-six (47%) underwent surgery in the first month of life. Forty-seven (33%) had the pathologic transition zone documented laparoscopically or through a small umbilical incision before beginning the anal dissection. Mean blood loss was 16 mL, and no patients required transfusion. Mean time to full feeding was 36 hours, mean postoperative hospital stay was 3.4 days, and 87 patients (62%) required only acetaminophen for pain. Early postoperative complications included perianal excoriation (11%), enterocolitis (6%), and stricture (4%). One patient died of congenital cardiac disease. Mean follow-up was 20 months; 81% had normal bowel function for age, 18% had minor problems, and 1% had major problems. Two patients required a second operation (twisted pullthrough, and residual aganglionosis). One patient developed postoperative adhesive bowel obstruction.
  
  
  CONCLUSIONS
  To date, this report represents the largest series of patients undergoing the 1-stage transanal Soave pullthrough. This approach is safe, permits early feeding, causes minimal pain, facilitates early discharge, and presents a low rate of complications.
authors.affiliation: Department of Surgery, University of Toronto, Toronto, Ontario, Canada. jacob.langer@sickkids.ca
authors.forename: Jacob C
authors.initials: JC
authors.lastname: Langer
authors.forename: Audrey C
authors.initials: AC
authors.lastname: Durrant
authors.forename: Luis
authors.initials: L
authors.lastname: de la Torre
authors.forename: Daniel H
authors.initials: DH
authors.lastname: Teitelbaum
authors.forename: Robert K
authors.initials: RK
authors.lastname: Minkes
authors.forename: Michael G
authors.initials: MG
authors.lastname: Caty
authors.forename: Barbara E
authors.initials: BE
authors.lastname: Wildhaber
authors.forename: S Jose
authors.initials: SJ
authors.lastname: Ortega
authors.forename: Shinjiro
authors.initials: S
authors.lastname: Hirose
authors.forename: Craig T
authors.initials: CT
authors.lastname: Albanese
mesh_terms: D002648:Child; D002675:Child, Preschool; D013505:Digestive System Surgical Procedures / Q000379:methods*; D005260:Female; D006627:Hirschsprung Disease / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D012086:Reoperation; D012189:Retrospective Studies; D016896:Treatment Outcome