title: Transanal one-stage endorectal pull-through for Hirschsprung's disease: a multicenter study.
abstract: OBJECTIVE
  Transanal endorectal pull-through (TEPT) is the latest development in treatment of Hirschsprung's disease (HD). This prospective study was designed to evaluate the safety and efficacy of 1 stage TEPT technique in the management of patients with HD.
  
  
  METHODS
  One hundred forty-nine children (116 boys and 33 girls) aged 8 days to 14 years underwent 1 stage TEPT procedure over an 18-month period at 5 Egyptian academic pediatric surgical centers and affiliated hospitals. Median follow-up was 12 months (range, 3 to 21 months). These patients were evaluated with regard to age, sex, length of the aganglionic segment, intraoperative details, and postoperative functional results or complications. An electromyogram (EMG), endorectal ultrasound scan, and lower gastrointestinal (GI) motility studies were reserved for patients with postoperative problems with bowel control.
  
  
  RESULTS
  Mean operating time was 120.2 +/- 27.8 minutes (range, 60 to 210 minutes). The average length of resected bowel was 26.8 +/- 12.4 cm (range, 15 to 45 cm). Thirteen patients required laparotomy because of extension of aganglionic segment beyond the sigmoid colon in 9, tear in the mesenteric vessels in 2, and difficulties in getting to the submucosal plane in 2. Three deaths (2%) occurred 3 days, 4 days, and 4 weeks postoperatively, respectively. Postoperative complications included transient perianal excoriation in 48 patients (30 were <3 months of age), enterocolitis (n = 26), anastomotic stricture (n = 7), recurrent constipation (n = 6), hypoganglionosis at distal end of pulled through segment (n = 2), cuff abscess (n = 3), anastomotic leak (n = 1), adhesive bowel obstruction (n = 1), and rectal prolapse (n = 1). Complete anorectal continence was noted in 35 of 42 (83.3%) children older than 3 years, whereas soiling and frequent accidents still occur in 7, who showed a steady improvement in their continence status.
  
  
  CONCLUSIONS
  One-stage TEPT technique is both feasible and safe technique in properly selected children with rectosigmoid HD in all ages. The technique is easily learned and is associated with excellent clinical results.
authors.affiliation: Department of Pediatric Surgery, Tanta University, Tanta, Egypt.
authors.forename: Essam A
authors.initials: EA
authors.lastname: Elhalaby
authors.forename: A
authors.initials: A
authors.lastname: Hashish
authors.forename: M M
authors.initials: MM
authors.lastname: Elbarbary
authors.forename: H A
authors.initials: HA
authors.lastname: Soliman
authors.forename: M K
authors.initials: MK
authors.lastname: Wishahy
authors.forename: A
authors.initials: A
authors.lastname: Elkholy
authors.forename: S
authors.initials: S
authors.lastname: Abdelhay
authors.forename: M
authors.initials: M
authors.lastname: Elbehery
authors.forename: N
authors.initials: N
authors.lastname: Halawa
authors.forename: T
authors.initials: T
authors.lastname: Gobran
authors.forename: S
authors.initials: S
authors.lastname: Shehata
authors.forename: N
authors.initials: N
authors.lastname: Elkhouly
authors.forename: A F
authors.initials: AF
authors.lastname: Hamza
mesh_terms: D000293:Adolescent; D001003:Anal Canal; D000714:Anastomosis, Surgical; D002648:Child; D002675:Child, Preschool; D003082:Colectomy / Q000009:adverse effects / Q000379:methods*; D003106:Colon / Q000294:innervation / Q000601:surgery*; D005260:Female; D006627:Hirschsprung Disease / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D019060:Minimally Invasive Surgical Procedures; D011183:Postoperative Complications; D011446:Prospective Studies; D016896:Treatment Outcome