title: Endorectal pull-through for Hirschsprung's disease-a multicenter, long-term comparison of results: transanal vs transabdominal approach.
abstract: 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.
authors.affiliation: Department of Surgery, Section of Pediatric Surgery, University of Michigan, Ann Arbor, Michigan 48109-0245, USA.
authors.forename: Anne C
authors.initials: AC
authors.lastname: Kim
authors.forename: Jacob C
authors.initials: JC
authors.lastname: Langer
authors.forename: Aimee C
authors.initials: AC
authors.lastname: Pastor
authors.forename: Lingling
authors.initials: L
authors.lastname: Zhang
authors.forename: Cornelius E J
authors.initials: CE
authors.lastname: Sloots
authors.forename: Nicholas A
authors.initials: NA
authors.lastname: Hamilton
authors.forename: Matthew D
authors.initials: MD
authors.lastname: Neal
authors.forename: Brian T
authors.initials: BT
authors.lastname: Craig
authors.forename: Erin K
authors.initials: EK
authors.lastname: Tkach
authors.forename: David J
authors.initials: DJ
authors.lastname: Hackam
authors.forename: Nicolaas M A
authors.initials: NM
authors.lastname: Bax
authors.forename: Patrick A
authors.initials: PA
authors.lastname: Dillon
authors.forename: Jennifer N
authors.initials: JN
authors.lastname: Chamberlain
authors.forename: Daniel H
authors.initials: DH
authors.lastname: Teitelbaum
mesh_terms: 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