Endorectal pull-through for Hirschsprung's disease—a multicenter, long-term comparison of results: transanal vs transabdominal approach |
| |
Authors: | Anne C. Kim Aimee C. Pastor Cornelius E.J. Sloots Matthew D. Neal Erin K. Tkach Nicolaas M.A. Bax Jennifer N. Chamberlain |
| |
Affiliation: | a Department of Surgery, Section of Pediatric Surgery, University of Michigan, Ann Arbor, Mich 48109-0245 b Division of Pediatric Surgery, Hospital for Sick Children, Toronto, Ontario, Canada c Center for Statistical Consultation and Research, University of Michigan, Ann Arbor, Mich 48109-0245 d Division of Pediatric Surgery, Erasmus Medical Center, Rotterdam, The Netherlands e Division of Pediatric Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pa f Division of Pediatric Surgery, Washington University in St Louis, St Louis, Mo |
| |
Abstract: | PurposePrevious studies have reported decreased continence in patients undergoing transanal endorectal pull-through (TERP) for Hirschsprung's disease compared to the older transabdominal approach (TAA). To address this, we examined long-term stooling outcomes in a large, multicenter cohort of patients undergoing either TERP or TAA.MethodsData were collected from 5 large pediatric institutions. Patient families were surveyed using a stooling score system (0-40, best to worst total score). Inclusion criteria included patients older than 3 years and those who had more than 6 months of recovery after pull-through. Those with total colonic aganglionosis were excluded. Statistical analysis included univariate and multivariate linear regression (significance, P < .05).ResultsTwo hundred eighty-one patients underwent TERP (192) or TAA (89). Interviews were completed in 149 (104 [52%] TERP vs 45 [52%] TAA). The TAA group had a significantly greater number of daily bowel movements for each respective postoperative year and experienced more early complications (3% vs 1% with >1 complication; P = .061) and late complications (19% vs 4% with >1 complication; P < .001). Although the TAA group had a higher mean enterocolitis score (3.3 ± 0.4 vs 1.8 ± 0.2; P < .001), this was not borne out by multivariate regression analysis (P = .276). Parental survey showed that there were no significant differences between procedures in mean total, continence, or stooling pattern scores.ConclusionTransanal endorectal pull-through was associated with fewer complications and fewer episodes of enterocolitis. In contrast to prior studies, TERP patients did not have a higher rate of incontinence. These results support use of TERP as an excellent surgical approach for children with Hirschsprung's disease. |
| |
Keywords: | Hirschsprung's disease Pull-through Continence Enterocolitis Stooling |
本文献已被 ScienceDirect 等数据库收录! |
|