title: [Complication analysis of endorectal pull-through radical operation for Hirschsprung disease].
abstract: OBJECTIVE
  To summarize the complications after endorectal pull-through radical operation, Soave procedure, for Hirschsprung disease.
  
  
  METHODS
  Clinical data of 286 cases with Hirschsprung disease who received Soave procedure and were proved by postoperative pathology in our hospital from February 2003 to February 2010 were analyzed retrospectively. All the patients were diagnosed with barium enema and anorectal manometry. Among them, 233 cases(81.5%) were identified during neonatal period. All the patients underwent cleansing enema and anus dilation immediately after definite diagnosis. Radical operation with Soave endorectal pull-through procedure, including simple transanal endorectal pull-through in 251 cases(87.8%), transabdominal approach in 17 cases (5.9%), laparoscopy-assisted endorectal pull-through in 18 cases (6.3%). The operations were performed in 54 cases (18.9%) within 3 months of age, in 183 cases (64.1%) between 3 and 6 months, in 38 cases(13.3%) between 6 months and one year, in 10 cases (3.5%) older than 1 year. The rectosigmoid was resected in 259 cases. Subtotal colectomy was performed in 25 cases, and total colectomy in 2 cases. Postoperative regular anal dilation lasted for 6 months. A total of 286 cases (male:250, female:36) were followed up for 2 to 5 years.
  
  
  RESULTS
  There was wound infection in 1 case, ileus in 1 cases, anastomotic stricture in 1 case, which was cured by continuous anal dilation. Two cases had constipation and received re-operation because of refractory to conservative therapy for 6 months. Perianal erosion was found in 63 cases(22.0%) and was healed within 3 months, except 2 children undergoing total colectomy. During follow-up, enterocolitis occurred in 11 cases(3.8%), including healing in 8 cases with conservative therapy, death in 1 case, and recurrent attacks in 2 cases. Soiling occurred in 45 cases(15.7%), among them, 5 cases presented in kindergarten and primary school. Morbidities of perianal erosion, enterocolitis and soiling were higher in infants undergoing operation within 3 months as compared to those more than 3 months [90.7%(49/63) vs. 6.0%(14/63), P=0.000; 9.3%(5/54) vs. 2.6%(6/232), P=0.022; 25.9%(14/54) vs. 13.4%(31/232), P=0.022]. Morbidity of perianal erosion enterocolitis was higher in infants undergoing subtotal or total colectomy as compared to those partial colon resection[51.9%(14/27) vs. 18.9%(49/259), P=0.000; 18.5%(5/27) vs. 2.3%(6/259), P=0.000].
  
  
  CONCLUSIONS
  Primary transanal endorental pull-through procedure can be performed in most children with Hirschsprung disease. Postoperative short-term complications are mainly perianal erosion and long-term ones are enterocolitis and soiling. Early diagnosis, colon irrigation, avoiding premature operation and anal dilation can decrease the morbidities of enterocolitis and soiling.
authors.affiliation: Department of Surgery, The Children's Hospital of Shanxi Province, Taiyuan 030013, China. chenlanping100@aliyun.com.
authors.forename: Xiaobing
authors.initials: X
authors.lastname: Sun
authors.forename: Hongxia
authors.initials: H
authors.lastname: Ren
authors.forename: Shuyun
authors.initials: S
authors.lastname: Chen
authors.forename: Xiaoxia
authors.initials: X
authors.lastname: Wu
authors.forename: Baohong
authors.initials: B
authors.lastname: Zhao
authors.forename: Yuanyuan
authors.initials: Y
authors.lastname: Jin
authors.forename: Lanping
authors.initials: L
authors.lastname: Chen
mesh_terms: D000714:Anastomosis, Surgical; D003082:Colectomy; D012809:Colon, Sigmoid; D003248:Constipation; D004733:Enema; D005260:Female; D006627:Hirschsprung Disease; D006801:Humans; D007223:Infant; D010535:Laparoscopy; D008297:Male; D010502:Perineum; D011183:Postoperative Complications; D011184:Postoperative Period; D012007:Rectum; D012189:Retrospective Studies