title: Continuous transanal decompression for infants with long- and total-type Hirschsprung's diseases as a bridge to curative surgery: a single-center experience.
abstract: BACKGROUND
  The purpose of this study is to assess the usefulness of continuous bowel decompression using an indwelling transanal tube (ITT) for preoperative management in infants with long-segment (L)- or total (T)-type Hirschsprung's disease (HD).
  
  
  METHODS
  Between 2012 and 2015, seven patients with L- or T-type HD underwent preoperative bowel management by continuous bowel decompression using an ITT during waiting period for curative surgery. Continuous bowel decompression was done using an ITT, a 10-12F flexible dual lumen tube placed through the rectum up to the dilated colon under fluoroscopic guidance and secured to the bilateral buttocks. The ITT tips were located at least in a dilated colon or the cecum if there was no radiographic transitional zone. The ITT was left open for continuous drainage, and its patency was checked by regular suction until the curative operation. The patient status and complications of this preoperative management were reviewed retrospectively.
  
  
  RESULTS
  The median duration of decompression management was 65 (17-137) days. During decompression period, neither abdominal distention, enterocolitis, nor other complications occurred and six patients could stay at home until the curative operation. The weight-for-age Z-score at curative surgery was the same as or higher than that at birth in five patients. ITT replacement was needed three times per patient on an average for accidental ITT removal, ITT stenosis, or ITT hardening.
  
  
  CONCLUSIONS
  Bowel management by continuous bowel decompression using an ITT is easy, safe, and effective for preoperative management in patients with L- or T-type HD and may permit single-stage surgery rendering colostomy or enterostomy unnecessary.
authors.affiliation: Department of Surgery, Kanagawa Children's Medical Center, 2-138-4 Mutsukawa, Minami-ku, Yokohama, 232-0066, Japan. kmochizuki@kcmc.jp.
authors.forename: Kyoko
authors.initials: K
authors.lastname: Mochizuki
authors.affiliation: Department of Surgery, Kanagawa Children's Medical Center, 2-138-4 Mutsukawa, Minami-ku, Yokohama, 232-0066, Japan.
authors.forename: Masato
authors.initials: M
authors.lastname: Shinkai
authors.affiliation: Department of Surgery, Kanagawa Children's Medical Center, 2-138-4 Mutsukawa, Minami-ku, Yokohama, 232-0066, Japan.
authors.forename: Norihiko
authors.initials: N
authors.lastname: Kitagawa
authors.affiliation: Department of Surgery, Kanagawa Children's Medical Center, 2-138-4 Mutsukawa, Minami-ku, Yokohama, 232-0066, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Take
authors.affiliation: Department of Surgery, Kanagawa Children's Medical Center, 2-138-4 Mutsukawa, Minami-ku, Yokohama, 232-0066, Japan.
authors.forename: Hidehito
authors.initials: H
authors.lastname: Usui
authors.affiliation: Department of Surgery, Kanagawa Children's Medical Center, 2-138-4 Mutsukawa, Minami-ku, Yokohama, 232-0066, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Hosokawa
authors.affiliation: Department of Surgery, Kanagawa Children's Medical Center, 2-138-4 Mutsukawa, Minami-ku, Yokohama, 232-0066, Japan.
authors.forename: Kaori
authors.initials: K
authors.lastname: Yamoto
keywords: Children; Hirschsprung’s disease; Long-segment type; Total type; Transanal decompression