Endorectal pull-through for Hirschsprung's disease-a multicenter, long-term comparison of results: transanal vs transabdominal approach.
OBJECTIVE
Previous studies have reported decreased continence in patients undergoing transanal endorectal pull-through (TERP) for Hirschsprung's disease compared to the older transabdominal approach (TAA). To address this, we examined long-term stooling outcomes in a large, multicenter cohort of patients undergoing either TERP or TAA.


METHODS
Data were collected from 5 large pediatric institutions. Patient families were surveyed using a stooling score system (0-40, best to worst total score). Inclusion criteria included patients older than 3 years and those who had more than 6 months of recovery after pull-through. Those with total colonic aganglionosis were excluded. Statistical analysis included univariate and multivariate linear regression (significance, P < .05).


RESULTS
Two hundred eighty-one patients underwent TERP (192) or TAA (89). Interviews were completed in 149 (104 [52%] TERP vs 45 [52%] TAA). The TAA group had a significantly greater number of daily bowel movements for each respective postoperative year and experienced more early complications (3% vs 1% with >1 complication; P = .061) and late complications (19% vs 4% with >1 complication; P < .001). Although the TAA group had a higher mean enterocolitis score (3.3 +/- 0.4 vs 1.8 +/- 0.2; P < .001), this was not borne out by multivariate regression analysis (P = .276). Parental survey showed that there were no significant differences between procedures in mean total, continence, or stooling pattern scores.


CONCLUSIONS
Transanal endorectal pull-through was associated with fewer complications and fewer episodes of enterocolitis. In contrast to prior studies, TERP patients did not have a higher rate of incontinence. These results support use of TERP as an excellent surgical approach for children with Hirschsprung's disease.
Kim
Anne C
AC
Department of Surgery, Section of Pediatric Surgery, University of Michigan, Ann Arbor, Michigan 48109-0245, USA.
Langer
Jacob C
JC
Pastor
Aimee C
AC
Zhang
Lingling
L
Sloots
Cornelius E J
CE
Hamilton
Nicholas A
NA
Neal
Matthew D
MD
Craig
Brian T
BT
Tkach
Erin K
EK
Hackam
David J
DJ
Bax
Nicolaas M A
NM
Dillon
Patrick A
PA
Chamberlain
Jennifer N
JN
Teitelbaum
Daniel H
DH
D002648:Child; D002675:Child, Preschool; D003113:Colonoscopy / Q000379:methods*; D003672:Defecation; D004210:Dissection / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006627:Hirschsprung Disease / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D007413:Intestinal Mucosa / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D012007:Rectum / Q000601:surgery*; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome