Role of Trans-Anal Endorectal Pull-Through in Complicated Hirschsprung’s Disease: Experience in 18 Patient.
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Abstract
Background/Purpose: In Hirschsprung’s disease (HD) redo pull-through (PT) is indicated for
anastomotic complications and for persistent aganglionosis after previous definitive surgery. This study
was undertaken to evaluate the role of transanal approach to redo PT procedure in the management of
complicated cases of HD over the last 7 years.
Patients and Methods: Between November 1998 and September 2005, 225 patients with HD were
operated using the transanal endorectal PT (TEPT) approach. Eighteen patients had a redo PT owing to
persistent aganglionosis.
The present study evaluates the role of TEPT approach in patients with persistent aganglionosis (n = 18).
Three patients needed a colostomy (n = 2) or ileostomy (n = 1) before the final operation. All the 18
patients underwent transanal mobilization (TEPT) of the colon. Six patients required additional
mobilization of the proximal colon (n = 4) and the ileum (n = 2) during the redo PT operation.
Results: Median follow-up was 43 months (range, 3-72 months). Sixteen patients have had a good
outcome with stool pattern 1 to 4 times daily. One patient had obstructive symptoms for 4 months
postoperatively but then settled. One patient has occasional soiling.
Conclusions: In this series, TEPT and posterior midline split of the muscle cuff were used with good
results. This has the advantage of avoiding injury to the pelvic muscles and nerves. The TEPT approach
is combined with transabdominal mobilization of the intestine depending on the length of the
aganglionic segment. The outcome has been favorable, but long-term follow-up is necessary for full
assessment of those patients