title: Comparison of the postoperative bowel function between transanal endorectal pull-through and transabdominal pull-through for Hirschsprung's disease: a study of the feces excretion function using an RI-defecogram.
abstract: OBJECTIVE
  Herein, we compared the bowel function after a transabdominal and a transanal procedure for Hirschsprung's disease (HD) using the clinical score and a quantitative evaluation of the feces excretion function based on the findings of an RI-defecogram.
  
  
  METHODS
  The subjects included 35 patients with short segment aganglionosis. In the two groups with transabdominal Z-shaped anastomosis (open group) and transanal endorectal pull-through (TEPT) (transanal group), the postoperative bowel function were evaluated based on the clinical score. In the RI-defecogram study, a time-activity curve was drawn for the (99m)Tc remaining in the rectum on defecation. The feces excretion function was thus quantified, with the time until the (99m)Tc in the rectum became 50% as T0.5 and the time until 90% of the feces were excreted from the rectum as T0.9.
  
  
  RESULTS
  The clinical score could be evaluated in 9 cases in the open group and in 15 cases in the transanal group. No significant difference was observed in the total clinical score between the two groups, but the urge to defecate and the constipation scores in the subcategories were significantly lower in the open group. The defecogram was performed included seven cases in the open group and five cases in the transanal group. When an analysis of covariance of the two groups was conducted for the T0.5 and T0.9 values using the postoperative months as a covariate, there was a significantly negative slope, and moreover, there was a significant difference between the two groups.
  
  
  CONCLUSIONS
  The RI-defecogram showed that feces excretion time improves with the postoperative months in both the groups, but the transanal group has higher feces excretion function in the early postoperative period compared with the open group. We consider the RI-defecogram to therefore be a useful examination method for evaluating the feces excretion function.
authors.affiliation: Department of Pediatric Surgery, Kanazawa Medical University, 1-1 Daigaku, Uchinada-machi, Kahoku-gun, Ishikawa, 920-0293, Japan. miyuki@kanazawa-med.ac.jp
authors.forename: Miyuki
authors.initials: M
authors.lastname: Kohno
authors.forename: Hiromichi
authors.initials: H
authors.lastname: Ikawa
authors.forename: Kunio
authors.initials: K
authors.lastname: Konuma
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Masuyama
authors.forename: Hironori
authors.initials: H
authors.lastname: Fukumoto
authors.forename: Eri
authors.initials: E
authors.lastname: Ogawa
authors.forename: Takahiro
authors.initials: T
authors.lastname: Oshikiri
authors.forename: Sadayoshi
authors.initials: S
authors.lastname: Takahashi
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003672:Defecation; D019841:Defecography; D013505:Digestive System Surgical Procedures / Q000379:methods; D006627:Hirschsprung Disease / Q000601:surgery*; D006801:Humans; D007422:Intestines / Q000502:physiology*; D019275:Radiopharmaceuticals; D013667:Technetium
chemical_list: D019275:Radiopharmaceuticals; D013667:Technetium
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