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One-stage transanal Soave pullthrough for Hirschsprung disease: a multicenter experience with 141 children.
Ann Surg. 2003 Oct; 238(4):569-83; discussion 583-5.AnnS

Abstract

BACKGROUND

The surgical management of Hirschsprung's disease (HD) has evolved from the original 3-stage approach to the recent introduction of minimal-access single-stage techniques. We reviewed the early results of the transanal Soave pullthrough from 6 of the original centers to use it.

METHODS

The clinical course of all children with HD undergoing a 1-stage transanal Soave pullthrough between 1995 and 2002 were reviewed. Children with a preliminary stoma or total colonic disease were excluded.

RESULTS

There were 141 patients. Mean time between diagnosis and surgery was 32 days, and mean age at surgery was 146 days. Sixty-six (47%) underwent surgery in the first month of life. Forty-seven (33%) had the pathologic transition zone documented laparoscopically or through a small umbilical incision before beginning the anal dissection. Mean blood loss was 16 mL, and no patients required transfusion. Mean time to full feeding was 36 hours, mean postoperative hospital stay was 3.4 days, and 87 patients (62%) required only acetaminophen for pain. Early postoperative complications included perianal excoriation (11%), enterocolitis (6%), and stricture (4%). One patient died of congenital cardiac disease. Mean follow-up was 20 months; 81% had normal bowel function for age, 18% had minor problems, and 1% had major problems. Two patients required a second operation (twisted pullthrough, and residual aganglionosis). One patient developed postoperative adhesive bowel obstruction.

CONCLUSION

To date, this report represents the largest series of patients undergoing the 1-stage transanal Soave pullthrough. This approach is safe, permits early feeding, causes minimal pain, facilitates early discharge, and presents a low rate of complications.

Authors+Show Affiliations

Department of Surgery, University of Toronto, Toronto, Ontario, Canada. jacob.langer@sickkids.caNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Multicenter Study

Language

eng

PubMed ID

14530728

Citation

Langer, Jacob C., et al. "One-stage Transanal Soave Pullthrough for Hirschsprung Disease: a Multicenter Experience With 141 Children." Annals of Surgery, vol. 238, no. 4, 2003, pp. 569-83; discussion 583-5.
Langer JC, Durrant AC, de la Torre L, et al. One-stage transanal Soave pullthrough for Hirschsprung disease: a multicenter experience with 141 children. Ann Surg. 2003;238(4):569-83; discussion 583-5.
Langer, J. C., Durrant, A. C., de la Torre, L., Teitelbaum, D. H., Minkes, R. K., Caty, M. G., Wildhaber, B. E., Ortega, S. J., Hirose, S., & Albanese, C. T. (2003). One-stage transanal Soave pullthrough for Hirschsprung disease: a multicenter experience with 141 children. Annals of Surgery, 238(4), 569-83; discussion 583-5.
Langer JC, et al. One-stage Transanal Soave Pullthrough for Hirschsprung Disease: a Multicenter Experience With 141 Children. Ann Surg. 2003;238(4):569-83; discussion 583-5. PubMed PMID: 14530728.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - One-stage transanal Soave pullthrough for Hirschsprung disease: a multicenter experience with 141 children. AU - Langer,Jacob C, AU - Durrant,Audrey C, AU - de la Torre,Luis, AU - Teitelbaum,Daniel H, AU - Minkes,Robert K, AU - Caty,Michael G, AU - Wildhaber,Barbara E, AU - Ortega,S Jose, AU - Hirose,Shinjiro, AU - Albanese,Craig T, PY - 2003/10/8/pubmed PY - 2003/11/8/medline PY - 2003/10/8/entrez SP - 569-83; discussion 583-5 JF - Annals of surgery JO - Ann Surg VL - 238 IS - 4 N2 - BACKGROUND: The surgical management of Hirschsprung's disease (HD) has evolved from the original 3-stage approach to the recent introduction of minimal-access single-stage techniques. We reviewed the early results of the transanal Soave pullthrough from 6 of the original centers to use it. METHODS: The clinical course of all children with HD undergoing a 1-stage transanal Soave pullthrough between 1995 and 2002 were reviewed. Children with a preliminary stoma or total colonic disease were excluded. RESULTS: There were 141 patients. Mean time between diagnosis and surgery was 32 days, and mean age at surgery was 146 days. Sixty-six (47%) underwent surgery in the first month of life. Forty-seven (33%) had the pathologic transition zone documented laparoscopically or through a small umbilical incision before beginning the anal dissection. Mean blood loss was 16 mL, and no patients required transfusion. Mean time to full feeding was 36 hours, mean postoperative hospital stay was 3.4 days, and 87 patients (62%) required only acetaminophen for pain. Early postoperative complications included perianal excoriation (11%), enterocolitis (6%), and stricture (4%). One patient died of congenital cardiac disease. Mean follow-up was 20 months; 81% had normal bowel function for age, 18% had minor problems, and 1% had major problems. Two patients required a second operation (twisted pullthrough, and residual aganglionosis). One patient developed postoperative adhesive bowel obstruction. CONCLUSION: To date, this report represents the largest series of patients undergoing the 1-stage transanal Soave pullthrough. This approach is safe, permits early feeding, causes minimal pain, facilitates early discharge, and presents a low rate of complications. SN - 0003-4932 UR - https://www.unboundmedicine.com/medline/citation/14530728/One_stage_transanal_Soave_pullthrough_for_Hirschsprung_disease:_a_multicenter_experience_with_141_children_ L2 - https://Insights.ovid.com/pubmed?pmid=14530728 DB - PRIME DP - Unbound Medicine ER -