title: Functional outcome after operation for Hirschsprung disease--transanal vs transabdominal approach.
abstract: BACKGROUND
  It has been hypothesized that the extensive transanal dissection in transanal endorectal pull-through (TEPT) for Hirschsprung disease (HD) can impair the anal sphincters in neonates and thereby cause incontinence. Theoretically, transabdominal endorectal pull-through might have less impact on the sphincters. The aim of this study was to compare functional outcome in HD patients operated with either TEPT or laparotomy-assisted endorectal pull-through (LEPT) with particular focus on soiling and fecal incontinence.
  
  
  METHODS
  Anorectal function in 52 children older than 3 years is reported. The patients were operated for HD with either TEPT (n = 28) or LEPT (n = 24) and followed prospectively. Functional outcome was recorded by standardized interviews. The Krickenbeck criteria were used to classify voluntary bowel movements, soiling, and constipation.
  
  
  RESULTS
  The median age at follow-up was 5.7 years (3.1-13.2) for TEPT and 10.1 years (7.7-16.2) for LEPT. Twenty-nine patients reported soiling at final follow-up. There was no difference in the rate of soiling between children operated with TEPT (54%) or LEPT (58%). Constipation was reported in 11 children (TEPT, 25%; LEPT, 17%).
  
  
  CONCLUSIONS
  The functional outcome and in particular the rate of soiling did not differ between patients operated with LEPT or TEPT.
authors: Department of Paediatric Surgery, Oslo University Hospital, Rikshospitalet, 0027 Oslo, Norway. kstensru@rikshospitalet.no
authors: Kjetil Juul
authors: KJ
authors: Stensrud
authors: Ragnhild
authors: R
authors: Emblem
authors: Kristin
authors: K
authors: Bjørnland
mesh_terms: D001003:Anal Canal / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D003106:Colon / Q000601:surgery; D003248:Constipation / Q000175:diagnosis / Q000628:therapy; D003672:Defecation / Q000502:physiology; D013505:Digestive System Surgical Procedures / Q000379:methods*; D005242:Fecal Incontinence / Q000175:diagnosis / Q000628:therapy; D006627:Hirschsprung Disease / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007813:Laparotomy / Q000379:methods; D008137:Longitudinal Studies; D011183:Postoperative Complications / Q000175:diagnosis / Q000628:therapy; D012007:Rectum / Q000601:surgery; D016896:Treatment Outcome