title: Transanal, full-thickness, Swenson-like approach for Hirschsprung disease.
abstract: OBJECTIVE
  Swenson's procedure for Hirschsprung disease (HD) was thought to disturb fecal, urinary, and ejaculatory functions leading to other approaches including the Soave and Duhamel techniques. Given our Center's experience with a full-thickness rectal dissection for anorectal malformations, and using the new transanal concept, we chose to apply these ideas to the primary treatment of HD, and describe technical aspects and impact on fecal, urinary, and sexual function.
  
  
  METHODS
  We reviewed our series of HD patients who underwent a transanal, Swenson-like rectosigmoid dissection, assessing for postoperative stricture, anastomotic leak, enterocolitis, and long-term results for bowel, urinary, and sexual function.
  
  
  RESULTS
  Of 67 patients, 28 had a transanal resection, 5 had transanal plus laparoscopy, and 34 had transanal plus laparotomy, of those, 28 patients had a leveling colostomy prior to referral. The average length of resection was 27 cm ± 12.7 cm. Mean follow-up was 17.2 months (range 1-96 months). 44 patients were at least three years old at follow-up and were assessed for urinary and fecal continence; all (100%) had voluntary bowel movements and urinary continence. Enterocolitis occurred in 9 patients (14%) and constipation (requiring laxatives) occurred in 21 (32%). Of 24 male patients, 21 (88%) reported the occurrence of spontaneous erections post-operatively.
  
  
  CONCLUSIONS
  Our data support the fact that a modification of Swenson's original transabdominal dissection concept using the recently described transanal approach is an excellent technique for Hirschsprung, and produces excellent long-term outcomes for fecal and urinary continence, and seems to preserve erectile function.
authors.affiliation: Colorectal Center for Children, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA. Electronic address: marc.levitt@cchmc.org.
authors.forename: Marc A
authors.initials: MA
authors.lastname: Levitt
authors.forename: Miller C
authors.initials: MC
authors.lastname: Hamrick
authors.forename: Balgopal
authors.initials: B
authors.lastname: Eradi
authors.forename: Andrea
authors.initials: A
authors.lastname: Bischoff
authors.forename: Jennifer
authors.initials: J
authors.lastname: Hall
authors.forename: Alberto
authors.initials: A
authors.lastname: Peña
mesh_terms: D001003:Anal Canal; D057868:Anastomotic Leak / Q000453:epidemiology / Q000209:etiology; D002648:Child; D002675:Child, Preschool; D012809:Colon, Sigmoid / Q000601:surgery*; D003125:Colostomy; D003248:Constipation / Q000453:epidemiology / Q000209:etiology; D004760:Enterocolitis / Q000453:epidemiology / Q000209:etiology; D007172:Erectile Dysfunction / Q000453:epidemiology / Q000209:etiology; D005242:Fecal Incontinence / Q000453:epidemiology / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006627:Hirschsprung Disease / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D010535:Laparoscopy; D007813:Laparotomy; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D012007:Rectum / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014549:Urinary Incontinence / Q000453:epidemiology / Q000209:etiology
keywords: Hirschsprung; Swenson; Transanal