Evaluation of the effect of one-stage transanal endorectal pull-through (TERPT) technique on defecation in patients with Hirschsprung’s Disease over the last 10 years in Tehran Pediatrics Medical Center
Iranian Journal of Pediatric Surgery,
Vol. 3 No. 2 (2017),
21 Bahman 2018
Introduction: One-stage Transanal Endorectal Pull-Through (TERPT) is one of the methods used for the treatment of Hirschsprung’s disease. The purpose of our study was to evaluate complications of surgery specially does related to defecation in patients undergoing pull-through surgery in Tehran Pediatrics Medical Center during the past 10 years.
Materials and Methods: This descriptive study was performed on patients undergoing one-stage TERPT operation in Tehran Pediatrics Medical Center over the past 10 years. Exclusion Criteria included: the parent’s lack of consent to participate in the study, age below 3 years and inability to complete the checklist. For all patients, a check list was completed that included: Age, family history of the disease, readmission, follow-up period, presence of soiling, complete or partial fecal incontinence, constipation, use of laxative, use of boogie, presence or absence of RectoAnal Inhibitory Reflex (RAIR) in manometers, stricture in rectal examination and enterocolitis before and after surgery. Data analysis was performed using SPSS software version 19.
Results: Our patients were 4.81% male and 3.9% of them had an underlying disease, such as heart or kidney disease. Only 6.81% of them had to be re-admitted due to enterocolitis. Soiling was found in 5.39% of patients, complete and partial fecal incontinence were noted in 3.2% and 7.4% of them respectively. The incidence of fecal incontinency was 7%. Constipation occurred in 6.11% of cases and 3.9% of cases did not have RAIR in manometry. The incidence of rectal stenosis was 7% and 93% of patients had transitional zone (TZ) in barium enema before the operation. The result showed that there was no significant relationship between post- operative complications in both sexes (p<0.05).
Conclusion: This study shows that the complications of Endorectal Transanal pull-through surgery as a method for treatment of Hirschsprung disease are infrequent. Therefore, this method can be considered as a selective method. Further investigations are recommended to prove this matter
- Hirschsprung’s Disease
- Transanal endorectal pull-through (TERPT)
- fecal Incontinency
How to Cite
Stensrud KJ, Emblem R, Bjørnland K: Functional outcome after operation for Hirschsprung disease—transanal vs transabdominal approach. Journal of Pediatric Surgery 2010;45(8):1640-4.
Zakaria OM, El Labban GM, Shams ME: Fecal incontinence after single-stage Soave’s pullthrough: abdominal versus transanal endorectal pull through. Annals of Pediatric Surgery 2012;8(1):5-8.
Coran AG, Caldamone A, Adzick NS, et al: Pediatric surgery. Elsevier Health Sciences, 2012.
Puri P: Variant Hirschsprung’s disease. Journal of Pediatric Surgery 1997;32(2):149-57.
Lewis NA, Levitt MA, Zallen GS, et al: Diagnosing Hirschsprung’s disease: increasing the odds of a positive rectal biopsy result. Journal of Pediatric Surgery 2003;38(3):412-6.
Mattar AF, Coran AG, Teitelbaum DH: MUC-2 mucin production in Hirschsprung’s disease: possible association with enterocolitis development. Journal of Pediatric Surgery 2003;38(3):417-21.
Zakaria OM: Bowel function and fecal continence after Soave’s trans anal endorectal pullthrough for Hirschsprung’s disease: a local experience. Updates in Surgery 2012;64(2):113-8.
De la Torre-Mondragon L, Ortega-Salgado J: Transanal endorectal pull-through for Hirschsprung’s disease. Journal of Pediatric Surgery 1998;33(8):1283-6.
Catto-Smith AG, Coffey CM, Nolan TM, et al: Fecal incontinence after the surgical treatment of Hirschsprung disease. The Journal of Pediatrics 1995;127(6):954-7.
Wang N-L, Lee H-C, Yeh M-L, et al: Experience with primary laparoscopy-assisted endorectal pull-through for Hirschsprung’s disease. Pediatric Surgery International 2004;20(2):118-22.
Yanchar NL, Soucy P: Long-term outcome after Hirschsprung’s disease: patients’ perspectives. Journal of Pediatric Surgery 1999;34(7):1152-60.
De la Torre L, Ortega A: Transanal versus open endorectal pull-through for Hirschsprung’s disease. Journal of Pediatric Surgery 2000;35(11):1630-2.
Langer JC, Durrant AC, de la Torre L, et al: One-stage transanal Soave pullthrough for Hirschsprung disease: a multicenter experience with 141 children. Annals of Surgery 2003;238(4):569-76.
- Abstract Viewed: 283 times
- PDF Downloaded: 137 times