title: Single-stage transanal endorectal pull-through procedure for correction of Hirschsprung disease in neonates and nonneonates: A multicenter study.
abstract: OBJECTIVE
  The outcomes of single-stage transanal endorectal pull-through (SSTEPT) for Hirschsprung disease (HSCR) in young patients are favorable; however, reports have shown that diagnosis and surgery at young ages increase the risk for postoperative enterocolitis and slows postoperative recovery. The present study was primarily designed to evaluate the outcomes of SSTEPT in a multi-institutional cohort of neonates and nonneonates with HSCR.
  
  
  METHODS
  Between August 2005 and May 2012, a total of 650 children with HSCR were divided into the following two groups: group A (neonatal group, operative age<28days [n=186]); and group B (nonneonatal group, operative age>28days [n=464]). The short-term outcomes were postoperative enterocolitis, perianal excoriation, and anastomotic stricture and leakage rates. The midterm outcomes were incomplete continence and constipation rates based on multi-institutional chart review. Statistical analyses were performed using chi-square (χ2) tests.
  
  
  RESULTS
  Follow-up was completed in 112 neonates and 303 nonneonates. Short-term outcomes indicated a higher incidence of perianal excoriation (27.6% vs. 6.6%, χ2=33.70, p<0.05), anastomotic strictures (14.3% vs. 6.0%, χ2=27.18, p<0.05), anastomotic leakage (8.0% vs. 1.7%, χ2=8.36, p<0.05), and postoperative enterocolitis (40.2% vs. 10.2%, χ2=49.05, p<0.05) in group A compared to group B. Midterm outcomes indicated a higher incidence of incomplete continence (35.7% vs. 14.9%, χ2=21.85, p<0.05) in group A compared to group B.
  
  
  CONCLUSIONS
  Performing single-stage transanal endorectal pull-through in the nonneonatal period may be more appropriate than the neonatal period. There were higher rates of perianal excoriation, anastomotic strictures and leakage, postoperative enterocolitis, and incomplete continence postoperatively in neonates than nonneonates.
authors.affiliation: Department of Pediatric Surgery, Children's Hospital Affiliated to Nanjing Medical University, Nanjing, China, 210008.
authors.forename: Changgui
authors.initials: C
authors.lastname: Lu
authors.affiliation: Department of Pediatric Surgery, Zhengzhou Children's Hospital, Zhengzhou, China, 450053.
authors.forename: Guangjun
authors.initials: G
authors.lastname: Hou
authors.affiliation: Department of Pediatric Surgery, Hebei Provincial Children's Hospital, Shijiazhuang, China, 050030.
authors.forename: Chunyi
authors.initials: C
authors.lastname: Liu
authors.affiliation: Department of Pediatric Surgery, Children's Hospital Affiliated to Nanjing Medical University, Nanjing, China, 210008.
authors.forename: Qiming
authors.initials: Q
authors.lastname: Geng
authors.affiliation: Department of Pediatric Surgery, Children's Hospital Affiliated to Nanjing Medical University, Nanjing, China, 210008.
authors.forename: Xiaoqun
authors.initials: X
authors.lastname: Xu
authors.affiliation: Department of Pediatric Surgery, Children's Hospital Affiliated to Nanjing Medical University, Nanjing, China, 210008.
authors.forename: Jie
authors.initials: J
authors.lastname: Zhang
authors.affiliation: Department of Pediatric Surgery, Children's Hospital Affiliated to Nanjing Medical University, Nanjing, China, 210008.
authors.forename: Huan
authors.initials: H
authors.lastname: Chen
authors.affiliation: Department of Pediatric Surgery, Children's Hospital Affiliated to Nanjing Medical University, Nanjing, China, 210008. Electronic address: twbcn@njmu.edu.cn.
authors.forename: Weibing
authors.initials: W
authors.lastname: Tang
mesh_terms: D000367:Age Factors; D001003:Anal Canal / Q000601:surgery*; D000714:Anastomosis, Surgical / Q000379:methods; D003082:Colectomy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006627:Hirschsprung Disease / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology*; D012007:Rectum / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
keywords: Hirschsprung disease; Neonate; Nonneonate; Outcome; Single-stage transanal endorectal pull-through (SSTEPT)