title: Long-term outcome of children after single-stage transanal endorectal pull-through for Hirschsprung's disease.
abstract: BACKGROUND
  single-stage transanal endorectal pull-through (TEPT) is a new technique for surgery of Hirschsprung's disease (HD). TEPT can be assisted by laparoscopy (laparoscopic assisted transanal pull-through, LATP) or with non-additional procedure (total transanal endorectal pull-through, TTEP). This study was undertaken to evaluate the long-term outcome of these approaches in children with HD.
  
  
  METHODS
  we retrospectively studied 131 patients (112 males and 19 females) aged 7 days to 14 years who underwent single-stage TEPT from October 2003 to July 2008. The medical records were reviewed for pre-, intra- and immediate post-operative complications. The data on stool pattern and complications were collected during the follow-up. Outcome was measured by continence evaluation score.
  
  
  RESULTS
  no patients had intraoperative complications, but 5 had minor immediate postoperative complications. Late postoperative complications in 12 patients included enterocolitis (4 patients, one with severe enterocolitis died 7 months after operation), soiling (6) and constipation (2). There was a significantly higher frequency of stool in patients aged more than 36 months and those with a resected colon more than 30 cm (P<0.05). LATP showed significantly higher frequency of stool and soiling (P<0.05). Of the 54 patients who were older than 3 years at the time of follow-up, continence score was normal in 10, good in 39, fair in 3, and poor in 2. Seventy-seven patients achieved good bowel control in 12.8 ± 8.11 months after operation, 93.5 5% of whom within 24 months. Stool function was not improved in patients more than 30 months old after operation.
  
  
  CONCLUSIONS
  the long-term outcome of single stage TEPT was excellent. There were few postoperative complications, and stool pattern improved gradually to an excellent level within 24 months. Internal plication can be a good option for reducing the dilated proximal colon.
authors.affiliation: Department of Pediatric Surgery, First Hospital Affiliated to Zhengzhou University, Zhengzhou, 450052, China.
authors.forename: Geha Raj
authors.initials: GR
authors.lastname: Dahal
authors.forename: Jia-Xiang
authors.initials: JX
authors.lastname: Wang
authors.forename: Li-Hua
authors.initials: LH
authors.lastname: Guo
mesh_terms: D000293:Adolescent; D001003:Anal Canal / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D003248:Constipation / Q000209:etiology; D013505:Digestive System Surgical Procedures / Q000379:methods; D004760:Enterocolitis / Q000209:etiology; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006627:Hirschsprung Disease / Q000150:complications / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D010535:Laparoscopy / Q000009:adverse effects; D008297:Male; D012007:Rectum / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome