title: Long-term outcome of bowel function for 110 consecutive cases of Hirschsprung's disease: Comparison of the abdominal approach with transanal approach more than 30years in a single institution - is the transanal approach truly beneficial for bowel function?
abstract: BACKGROUND
  We compared the long-term outcomes of the bowel function (BF) in Hirschsprung's disease (HD) patients who underwent transanal endorectal pull-through (TA) with those who underwent the Soave-Denda (SD) procedure.
  
  
  METHODS
  Patient data were collected from 1984 to 2015 from 110 HD patients who underwent definitive diagnosis and operation. The follow-up data were analyzed retrospectively. BF was evaluated according to the evacuation score (ES) of the Japan Society of Anorectal Malformation Study Group at 3, 5, 7, 9, and 11years of age.
  
  
  RESULTS
  The operative procedures performed were as follows: SD: 71 (64.5%), TA: 38 (34.5%), and Duhamel: 1 (1.0%). We compared SD with TA. The ES improved chronologically after both procedures, and patients achieved satisfactory results at least 10years after operation. There was no significant difference in the total ES at all ages. The incontinence and frequency of bowel movement scores of TA patients were significantly lower than those of SD patients at several points.
  
  
  CONCLUSIONS
  TA is simple, less invasive, and adaptive for neonates and small infants. However, regarding the bowel function, TA is not always superior to SD. The surgical technique of TA must be improved according to a detailed understanding of the anatomy.
  
  
  METHODS
  Retrospective study - level III.
authors.affiliation: Department of Pediatric Surgery, Research Field in Medical and Health Sciences, Medical and Dental Area, Research and Education Assembly, Kagoshima University.
authors.forename: Shun
authors.initials: S
authors.lastname: Onishi
authors.affiliation: Department of Pediatric Surgery, Research Field in Medical and Health Sciences, Medical and Dental Area, Research and Education Assembly, Kagoshima University.
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Nakame
authors.affiliation: Department of Pediatric Surgery, Research Field in Medical and Health Sciences, Medical and Dental Area, Research and Education Assembly, Kagoshima University.
authors.forename: Kouji
authors.initials: K
authors.lastname: Yamada
authors.affiliation: Department of Pediatric Surgery, Research Field in Medical and Health Sciences, Medical and Dental Area, Research and Education Assembly, Kagoshima University.
authors.forename: Waka
authors.initials: W
authors.lastname: Yamada
authors.affiliation: Department of Pediatric Surgery, Research Field in Medical and Health Sciences, Medical and Dental Area, Research and Education Assembly, Kagoshima University.
authors.forename: Takafumi
authors.initials: T
authors.lastname: Kawano
authors.affiliation: Department of Pediatric Surgery, Research Field in Medical and Health Sciences, Medical and Dental Area, Research and Education Assembly, Kagoshima University.
authors.forename: Motoi
authors.initials: M
authors.lastname: Mukai
authors.affiliation: Department of Pediatric Surgery, Research Field in Medical and Health Sciences, Medical and Dental Area, Research and Education Assembly, Kagoshima University.
authors.forename: Tatsuru
authors.initials: T
authors.lastname: Kaji
authors.affiliation: Department of Pediatric Surgery, Research Field in Medical and Health Sciences, Medical and Dental Area, Research and Education Assembly, Kagoshima University. Electronic address: sieiri@m.kufm.kagoshima-u.ac.jp.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Ieiri
mesh_terms: D002675:Child, Preschool; D003672:Defecation / Q000502:physiology*; D013505:Digestive System Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D005242:Fecal Incontinence / Q000209:etiology; D005260:Female; D006627:Hirschsprung Disease / Q000150:complications / Q000503:physiopathology* / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Bowel function; Hirschsprung's disease; Incontinence; Long-term outcome; Soave procedure; Transanal endorectal pull-through procedure