Technical problems and complications of a transanal pull-through for Hirschsprung's disease.
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.
Podevin
G
G
Department of Pediatric Surgery, Nantes Medical University, Nantes, France. guillaume.podevin@chu-nantes.fr
Lardy
H
H
Azzis
O
O
Branchereau
S
S
Petit
T
T
Sfeir
R
R
Weil
D
D
Heloury
Y
Y
Fremond
B
B