Transanal endorectal pull-through for classic segment Hirschsprung's disease: with or without laparoscopic mobilization of the rectosigmoid?
BACKGROUND
It has been suggested that the outcome of transanal endorectal pull-through for classic Hirschprung's disease can be improved by laparoscopically mobilizing the colon before the pullthrough.


METHODS
Charts of 43 patients (2005-2009) with proven recto-sigmoid aganglionosis were retrospectively analyzed with respect to postoperative outcomes. Twenty-one had been treated with the transanal endorectal pull through (TERPT) and 22 with the laparoscopically assisted TERPT (LTERPT).


RESULTS
Gender ratio, congenital anomalies, preoperative enterostomy, and follow up did not differ between the groups. More colon was resected in the TERPT group: median 25 cm vs. 15 cm in the L-TERPT group (p<0.001). The TERPT-procedure took less time: median 153 min. vs. L-TERPT 263 min (p<0.001). Postoperatively, three patients showed colonic torsions after TERPT (p=0.07). The long-term clinical outcomes did not differ significantly between both groups. There was a significant association between length of resection and obstructive symptoms (OR=0.92, p=0.01).


CONCLUSIONS
Postoperative and clinical outcomes are similar using the TERPT or L-TERPT to correct classic segment Hirschsprung's disease. Prevention of colonic torsion should be the prime concern during the TERPT procedure. L-TERPT requires laparoscopic equipment and takes more operation time, whereas TERPT leaves no visible scars. The positive relation between the larger length of resection and obstructive symptoms requires additional research.
Department of Pediatric Surgery, Erasmus MC - Sophia Children's Hospital, Rotterdam, The Netherlands; Department of Surgery - Pediatric Surgery, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands. Electronic address: T.vandeven@kchir.umcn.nl.
Teun J
TJ
van de Ven
Cornelius E J
CE
Sloots
Marc H W A
MH
Wijnen
Roxana
R
Rassouli
Iris
I
van Rooij
Rene M
RM
Wijnen
Ivo
I
de Blaauw
D000015:Abnormalities, Multiple; D001003:Anal Canal; D002675:Child, Preschool; D002921:Cicatrix / Q000517:prevention & control; D003106:Colon / Q000601:surgery*; D012809:Colon, Sigmoid / Q000601:surgery; D003108:Colonic Diseases / Q000209:etiology; D003248:Constipation / Q000209:etiology / Q000517:prevention & control / Q000628:therapy; D004733:Enema; D005260:Female; D006627:Hirschsprung Disease / Q000601:surgery*; D006801:Humans; D007223:Infant; D007415:Intestinal Obstruction / Q000209:etiology; D010535:Laparoscopy / Q000379:methods*; D054368:Laxatives / Q000627:therapeutic use; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D061646:Operative Time; D011182:Postoperative Care; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control; D012007:Rectum / Q000601:surgery*; D012189:Retrospective Studies; D014102:Torsion Abnormality / Q000209:etiology; D016896:Treatment Outcome
D054368:Laxatives
Hirschsprung's disease; Laparoscopic; Postoperative outcomes; Surgery; TEPT; TERPT