Transanal one-stage endorectal pull-through for Hirschsprung's disease: A multicenter study

被引:85
作者
Elhalaby, EA
Hashish, A
Elbarbary, MM
Soliman, HA
Wishahy, MK
Elkholy, A
Abdelhay, S
Elbehery, M
Halawa, N
Gobran, T
Shehata, S
Elkhouly, N
Hamza, AF
机构
[1] Tanta Univ, Dept Pediat Surg, Tanta, Egypt
[2] Cairo Univ, Specialized Pediat Hosp, Dept Pediat Surg, Cairo, Egypt
[3] Ain Shams Univ, Dept Pediat Surg, Cairo, Egypt
[4] Zagazig Univ, Dept Pediat Surg, Zagazig, Egypt
[5] Elshatby Childrens Hosp, Dept Pediat Surg, Alexandria, Egypt
关键词
Hirschsprung's disease; transanal pull-through; one-stage repair;
D O I
10.1016/j.jpedsurg.2003.11.038
中图分类号
R72 [儿科学];
学科分类号
100202 ;
摘要
Background/Purpose: Transanal endorectal pull-through (TEPT) is the latest development in treatment of Hirschsprung's disease (HD). This prospective study was designed to evaluate the safety and efficacy of 1 stage TEPT technique in the management of patients with HID. Methods: One hundred forty-nine children (116 boys and 33 girls) aged 8 days to 14 years underwent 1 stage TEPT procedure over an 18-month period at 5 Egyptian academic pediatric surgical centers and affiliated hospitals. Median follow-up was 12 months (range, 3 to 21 months). These patients were evaluated with regard to age, sex, length of the aganglionic segment, intraoperative details, and postoperative functional results or complications. An electromyogram (EMG), endorectal ultrasound scan, and lower gastrointestinal (GI) motility studies were reserved for patients with postoperative problems with bowel control. Results: Mean operating time was 120.2 +/- 27.8 minutes (range, 60 to 210 minutes). The average length of resected bowel was 26.8 +/- 12.4 cm (range, 15 to 45 cm). Thirteen patients required laparotomy because of extension of aganglionic segment beyond the sigmoid colon in 9, tear in the mesenteric vessels in 2, and difficulties in getting to the submucosal plane in 2. Three deaths (2%) occurred 3 days, 4 days, and 4 weeks postoperatively, respectively. Postoperative complications included transient perianal excoriation in 48 patients (30 were <3 months of age), enterocolitis (n = 26), anastomotic stricture (n 7), recurrent constipation (n = 6), hypoganglionosis at distal end of pulled through segment (n = 2), cuff abscess (n = 3), anastomotic leak (n = 1), adhesive bowel obstruction (n = 1), and rectal prolapse (n = 1). Complete anorectal continence was noted in 35 of 42 (83.3%) children older than 3 years, whereas soiling and frequent accidents still occur in 7, who showed a steady improvement in their continence status. Conclusions: One-stage TEPT technique is both feasible and safe technique in properly selected children with rectosigmoid HID in all ages. The technique is easily learned and is associated with excellent clinical results.
引用
收藏
页码:345 / 350
页数:6
相关论文
共 16 条
[1]   Perineal one-stage pull-through for Hirschsprung's disease [J].
Albanese, CT ;
Jennings, RW ;
Smith, B ;
Bratton, B ;
Harrison, MR .
JOURNAL OF PEDIATRIC SURGERY, 1999, 34 (03) :377-380
[2]  
BOLEY SJ, 1964, SURGERY, V56, P1015
[3]   Transanal versus open endorectal pull-through for Hirschsprung's disease [J].
De la Torre, L ;
Ortega, A .
JOURNAL OF PEDIATRIC SURGERY, 2000, 35 (11) :1630-1632
[4]   Transanal endorectal pull-through for Hirschsprung's disease [J].
De la Torre-Mondragón, L ;
Ortega-Salgado, JA .
JOURNAL OF PEDIATRIC SURGERY, 1998, 33 (08) :1283-1286
[5]   ENTEROCOLITIS ASSOCIATED WITH HIRSCHSPRUNGS-DISEASE - A CLINICAL RADIOLOGICAL CHARACTERIZATION BASED ON 168 PATIENTS [J].
ELHALABY, EA ;
CORAN, AG ;
BLANE, CE ;
HIRSCHL, RB ;
TEITELBAUM, DH .
JOURNAL OF PEDIATRIC SURGERY, 1995, 30 (01) :76-83
[6]   ENTEROCOLITIS ASSOCIATED WITH HIRSCHSPRUNGS-DISEASE - A CLINICAL HISTOPATHOLOGICAL CORRELATIVE STUDY [J].
ELHALABY, EA ;
TEITELBAUM, DH ;
CORAN, AG ;
HEIDELBERGER, KP .
JOURNAL OF PEDIATRIC SURGERY, 1995, 30 (07) :1023-1027
[7]   Submucosal pressure-air insufflation facilitates endorectal mucosectomy in transanal endorectal pull-through procedure in patients with Hirschsprung's disease [J].
Ergün, O ;
Çelik, A ;
Dökümcü, Z ;
Balik, E .
JOURNAL OF PEDIATRIC SURGERY, 2003, 38 (02) :188-190
[8]   Primary transanal rectosigmoidectomy for Hirschsprung's disease: Preliminary results in the initial 33 cases [J].
Gao, Y ;
Li, GC ;
Zhang, XS ;
Xu, Q ;
Guo, ZT ;
Zheng, BJ ;
Li, P ;
Li, GW .
JOURNAL OF PEDIATRIC SURGERY, 2001, 36 (12) :1816-1819
[9]   PRIMARY LAPAROSCOPIC PULL-THROUGH FOR HIRSCHSPRUNGS-DISEASE IN INFANTS AND CHILDREN [J].
GEORGESON, KE ;
FUENFER, MM ;
HARDIN, WD .
JOURNAL OF PEDIATRIC SURGERY, 1995, 30 (07) :1017-1022
[10]   The role of transanal endorectal pull-through in the treatment of Hirschsprung's disease -: a multicenter experience [J].
Höllwarth, ME ;
Rivosecchi, M ;
Schleef, J ;
Deluggi, S ;
Fasching, G ;
Ceriati, E ;
Ciprandi, G ;
DePeppo, F .
PEDIATRIC SURGERY INTERNATIONAL, 2002, 18 (5-6) :344-348