Soave transanal one-stage endorectal pull-through in the treatment of Hirschsprung's disease of the child above two-year-old: a report of 20 cases.
BACKGROUND
The definitive treatment of Hirschsprung's disease is the removal of the aganglionic bowel by a pull-through surgery. In most cases, this surgery is performed in infancy or in the neonatal period as presentation in older children and adulthood is uncommon.


METHODS
It is a retrospective study of 20 patients above two-year-old who underwent a transanal Soave one-stage endorectal pull-through procedure for Hirschsprung's disease between January 2002 and December 2010.


RESULTS
Twenty patients were recruited in this study. Fourteen were males and six were females. Patient ages ranged from 2 to 14 years (median age: five years and three months). All patients presented with persistent constipation and abdominal distension. Two of them had an intestinal obstruction that required colostomy. Ten patients (50%) had a recto-sigmoid Hirschsprung's disease. All patients were operated on using a Soave one-stage endorectal pull-through procedure. The laparoscopy was necessary during the pull-through in three cases. The average duration of the intervention was 240 minutes. That represents almost the double of the duration of the same procedure in newborns and infants in our department (130 minutes). Early postoperative complications included one case of anastomosis leakage and one case of intussusception. Late postoperative complications were perineum irritation in five cases (25%), anal stenosis in four cases (20%) and enterocolitis in one case (5%). None of our patients developed fecal incontinence. Soiling was reported in four cases (20%). There was no death.


CONCLUSIONS
Soave transanal one-stage endorectal pull-through is safely feasible in children of more than two years of age. Laparoscopy may be necessary whenever there are difficulties in the pull-through.
Department of Pediatric Surgery, Hospital Fattouma Bourguiba, Monastir 5000, Tunisia.
Amine
A
Ksia
Houssem
H
Yengui
Manel Ben
MB
Saad
Lassaad
L
Sahnoun
Kais
K
Maazoun
Laamiri
L
Rachida
Imed
I
Krichene
Mongi
M
Mekki
Mohsen
M
Belguith
Abdellatif
A
Nouri
D000293:Adolescent; D000367:Age Factors; D001003:Anal Canal; D002648:Child; D002675:Child, Preschool; D003082:Colectomy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006627:Hirschsprung Disease / Q000601:surgery*; D006801:Humans; D015994:Incidence; D010535:Laparoscopy; D008297:Male; D057605:Natural Orifice Endoscopic Surgery / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome; D014416:Tunisia / Q000453:epidemiology