title: Technical problems and complications of a transanal pull-through for Hirschsprung's disease.
abstract: BACKGROUND
  The purpose of this study was to evaluate the technical difficulties and complications of a transanal pull-through for Hirschsprung's disease.
  
  
  METHODS
  This report was based on a multicentric retrospective study of 65 cases. Pull-through procedures were transanal Swenson or Soave procedures in 26 and 39 cases, respectively.
  
  
  RESULTS
  Evaluation of the aganglionic level, peri-rectal dissection, and anastomosis were the three steps in the procedure where surgeons encountered difficulties. Such difficulties led to serious complications in 3 cases. A patient with a colon biopsy before the pull-through procedure had a postoperative pneumoperitoneum requiring a second laparoscopy for suture and washing. Another patient had peritonitis due to anastomotic leakage. Finally, a difficult rectal dissection in a neonate led to a urethral injury requiring secondary urethral repair. Only 41 of the 65 patients had no abdominal scars (63 %).
  
  
  CONCLUSIONS
  We considered the transanal pull-through for Hirschsprung's disease to be a reliable technique. Nevertheless, it requires an urethral stent, precise dissection, careful anastomosis and selected indications in order to avoid major complications.
authors: Department of Pediatric Surgery, Nantes Medical University, Nantes, France. guillaume.podevin@chu-nantes.fr
authors: G
authors: G
authors: Podevin
authors: H
authors: H
authors: Lardy
authors: O
authors: O
authors: Azzis
authors: S
authors: S
authors: Branchereau
authors: T
authors: T
authors: Petit
authors: R
authors: R
authors: Sfeir
authors: D
authors: D
authors: Weil
authors: Y
authors: Y
authors: Heloury
authors: B
authors: B
authors: Fremond