Functional outcome after operation for Hirschsprung disease--transanal vs transabdominal approach.
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.
Stensrud
Kjetil Juul
KJ
Department of Paediatric Surgery, Oslo University Hospital, Rikshospitalet, 0027 Oslo, Norway. kstensru@rikshospitalet.no
Emblem
Ragnhild
R
Bjørnland
Kristin
K
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