J Korean Assoc Pediatr Surg.  2016 Dec;22(2):38-41. 10.13029/jkaps.2016.22.2.38.

Single Stage Transanal Endorectal Pull-through Operation for Hirschsprung’s Disease in Neonate: A Single Center Experience

• Lee JY
• Choi JH
• Namgung JM
• Kim DY
• Kim SC

• KMID: 2363022
• DOI: http://doi.org/10.13029/jkaps.2016.22.2.38

Abstract

PURPOSE
The single stage transanal pull-through (SSPT) for Hirschsprung's disease is becoming the most popular procedure. This single center study compared the result of single stage operation with two-stage operation for Hirschsprung's disease in neonates.
METHODS
We retrospectively reviewed medical records of all patients who were diagnosed as Hirschsprung's disease and underwent SSPT or two-stage operation operation in Asan Medical Center between January 2003 and July 2014.
RESULTS
There were 17 SSPT and 28 two-stage operation. The mean age of SSPT group was 14.2±7.1 days, and the mean age of two-stage operation group was 15.4±8.6 days for stomy formation, and 188.6±36.3 days for Duhamel operation. The operation time of SSPT was shorter than Duhamel operation (145.0±37.0 minutes vs. 193.0±36.0 minutes, p<0.001). The mean follow-up period of SSPT and two-stage operation was 35.5±34.9 months (range, 2-132 months) and 56.6±35.5 months (range, 1-121 months), respectively. Defecation problem rate such as fecal soiling or fecal impaction showed no significant difference between the two groups (p=0.719). Two SSPT patients required botulinum toxin injection due to rectal stenosis. Three patients of SSPT group underwent re-do endorectal pull-through due to remnant aganglionic or hypoganglionic bowel.
CONCLUSION
The SSPT showed shorter hospital days. However, few patients experienced rectal stenosis, but were manageable with botulinum toxin injection. The SSPT requires experienced-pathologist, as well as surgeon, because intra-operation pathology reading is critical for appropriate SSPT. SSPT is a feasible and reasonable option to treat Hirschsprung's disease.

Keyword

Hirschsprung disease; Transanal pull-through; Single stage surgery; Newborn infant

MeSH Terms

Botulinum Toxins
Chungcheongnam-do
Constriction, Pathologic
Defecation
Fecal Impaction
Follow-Up Studies
Hirschsprung Disease
Humans
Infant, Newborn*
Medical Records
Pathology
Retrospective Studies
Soil
Botulinum Toxins
Soil

Reference

1. Georgeson KE, Fuenfer MM, Hardin WD. Primary laparoscopic pull-through for Hirschsprung's disease in infants and children. J Pediatr Surg. 1995; 30:1017–1021.

2. De la Torre-Mondragón L, Ortega-Salgado JA. Transanal endorectal pull-through for Hirschsprung's disease. J Pediatr Surg. 1998; 33:1283–1286.

3. Teitelbaum DH, Cilley RE, Sherman NJ, Bliss D, Uitvlugt ND, Renaud EJ, et al. A decade of experience with the primary pullthrough for Hirschsprung disease in the newborn period: a multicenter analysis of outcomes. Ann Surg. 2000; 232:372–380.

4. Langer JC, Durrant AC, de la Torre L, Teitelbaum DH, Minkes RK, Caty MG, et al. One-stage transanal Soave pull-through for Hirschsprung disease: a multicenter experience with 141 children. Ann Surg. 2003; 238:569–583.

5. Bhatiav P, Joshi SR, Ramji J, Bachani M, Uttarwar A. Single stage transanal pull-through for Hirschsprung's disease in neonates: our early experience. J Neonatal Surg. 2013; 2:39.

6. Vũ PA, Thien HH, Hiep PN. Transanal one-stage endorectal pull-through for Hirschsprung disease: experiences with 51 newborn patients. Pediatr Surg Int. 2010; 26:589–592.

7. Rhim SY, Jung PM. One-stage repair of neonatal Hirschsprung's disease. J Korean Assoc Pediatr Surg. 2007; 13:61–65.

8. Park BS, Sul JY. Primary laparoscopic-assisted endorectal pullthrough for Hirschsprung's disease. J Korean Assoc Pediatr Surg. 2013; 19:130–139.

9. Li AW, Zhang WT, Li FH, Cui XH, Duan XS. A new modification of transanal Soave pull-through procedure for Hirschsprung's disease. Chin Med J (Engl). 2006; 119:37–42.

10. Weidner BC, Waldhausen JH. Swenson revisited: a one-stage, transanal pull-through procedure for Hirschsprung's disease. J Pediatr Surg. 2003; 38:1208–1211.

11. Sulkowski JP, Cooper JN, Congeni A, Pearson EG, Nwomeh BC, Doolin EJ, et al. Single-stage versus multi-stage pull-through for Hirschsprung's disease: practice trends and outcomes in infants. J Pediatr Surg. 2014; 49:1619–1625.

12. Kim DY, Kim SC, Kim KM, Kim EAR, Kim KS, Kim JS, et al. Diagnosis of Hirschsprung's disease of neonate and infant. J Korean Assoc Pediatr Surg. 2002; 8:1–5.

13. Kim H, Kim DY, Kim SC, Namgoong JM, Hwang JH. How reliable are diagnostic methods of Hirschsprung disease? J Korean Assoc Pediatr Surg. 2014; 20:33–37.

14. Kim HY, Park KW, Chun YS, Jung SE, Lee SC, Kim WK. Re-pull-through operation in Hirschsprung's disease. J Korean Assoc Pediatr Surg. 2004; 10:1–8.