Further evidence on totally transanal one-stage pull-through procedure for Hirschsprung's disease.
OBJECTIVE
Fifteen consecutive children aged 20 days to 12 years with biopsy-proven Hirschsprung's Disease (HD) underwent a transanal pull-through procedure over a 17-month period. These patients have been divided into 2 groups. The first was a series of 9 patients, which helped us gain familiarity and confidence with technical and postoperative gestational problems, and the second series was of 6 patients, which fully corroborates and adds further evidence on the minimally invasive nature of the technique. Mucosectomy of aganglionic bowel, access to the peritoneal cavity, division of rectosigmoid mesenteric vessels, pull-through of normoganglionic colon, colectomy, and coloanal anastomosis all were performed transanally. Patients underwent a program of progressive anal dilatations and were assessed for postoperative clinical course, continence, constipation, diarrhea, postoperative enterocolitis, perianal excoriations, and anal stricture.


RESULTS
Mucosectomy was done under direct vision. Operating time ranged from 150 to 350 minutes. The average length of bowel resected was 13.5 cm with a range of 8 cm to 25 cm. There were neither intraoperative nor significant postoperative complications. All but 2 patients accepted full oral feedings on postoperative day 2. Mean hospital stay in the first series of 9 patients was 7 days, range, 5 to 12 days; that of the second series of 6 patients was 5 days, range, 4 to 8 days. All children currently experience 1 to 6 bowel movements per day at a follow-up period of 1 to 17 months.


CONCLUSIONS
A one-stage pull-through procedure for HD can be performed successfully with a completely transanal approach. This technique is associated with excellent early clinical results. Many more cases and a longer follow-up period will be required to compare long-term results with other one-stage procedures for definitive treatment of HD.
Department of Pediatric Surgery, University of Brescia and Civil Hospitals, Brescia, Italy.
George
G
Ekema
Diego
D
Falchetti
Fabio
F
Torri
Vittorio E
VE
Merulla
Alessandro
A
Manciana
Guido
G
Caccia
D001003:Anal Canal; D000714:Anastomosis, Surgical / Q000379:methods; D001706:Biopsy; D002648:Child; D002675:Child, Preschool; D003082:Colectomy / Q000379:methods*; D004106:Dilatation / Q000379:methods; D005500:Follow-Up Studies; D006627:Hirschsprung Disease / Q000473:pathology / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D011300:Preoperative Care; D016896:Treatment Outcome