Transanal mucosectomy for endorectal pull-through in Hirschsprung's disease: comparison of abdominal, extraanal and transanal approaches.
OBJECTIVE
The authors compared the clinical outcome between laparoscopically assisted endorectal pull-through (EPT) with an extraanal approach (EA) and conventional abdominal approach (AB) in Hirschsprung's disease (HD), and found that the former approach was less invasive and can provide a better clinical outcome. Recently, they introduced transanal approach (TA) without laparoscopical assistance and compared the clinical outcomes of these three approaches.


METHODS
In the period between 1990 and 1997, 20 cases of HD underwent EPT with AB (Group A), between 1998 and 2001, 21 cases underwent EPT with EA (Group E), and between 2004 and 2005, eight cases underwent EPT with TA (Group T). There was no difference in age and weight distribution among three groups. Clinical outcome was assessed 3 years after surgery.


RESULTS
The operation time in Groups A, E and T was comparable (4.9 +/- 0.8, 5.2 +/- 0.8 and 4.3 +/- 0.8 h), whereas blood loss (98 +/- 52, 36 +/- 30 and 36 +/- 30 ml) and the incidence of postoperative complications requiring surgical intervention (25, 0 and 0%) was significantly lower in Groups E and T compared with Group A. The incidence of postoperative enteritis (25, 29 and 13%) was lower in Group T compared with Groups A and E. In Group E, two cases had persistent constipation, which required anorectal myotomy. Voluntary defecation (>once/2 days) was comparable among the groups (70, 87 and 88%). Soiling (small amount of involuntary passage of stool) was significantly less frequent in Groups E and T (45, 14 and 0%).


CONCLUSIONS
EPT with perineal approaches is less invasive and can provide a better clinical outcome than EPT with AB in terms of postoperative soiling. Compared with EA and TA, EA tended to develop stagnant enteritis or residual constipation.
Ishikawa
Nobuki
N
Department of Pediatric Surgery, Osaka Medical Center and Research Institute for Maternal and Child Health, 840 Murodo-cho, Izumi, Osaka 594-1101, Japan. nobu_63692007@yahoo.co.jp
Kubota
Akio
A
Kawahara
Hisayoshi
H
Hasegawa
Toshimichi
T
Okuyama
Hiroomi
H
Uehara
Syuichiro
S
Mitani
Yasuyuki
Y
D016063:Blood Loss, Surgical; D003248:Constipation / Q000209:etiology; D013505:Digestive System Surgical Procedures / Q000379:methods*; D004751:Enteritis / Q000209:etiology; D005242:Fecal Incontinence / Q000209:etiology; D006627:Hirschsprung Disease / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007413:Intestinal Mucosa / Q000601:surgery*; D011183:Postoperative Complications