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Endorectal pull-through for Hirschsprung's disease-a multicenter, long-term comparison of results: transanal vs transabdominal approach.
J Pediatr Surg. 2010 Jun; 45(6):1213-20.JP

Abstract

PURPOSE

Previous 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.

METHODS

Data 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).

RESULTS

Two 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.

CONCLUSION

Transanal 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.

Authors+Show Affiliations

Department of Surgery, Section of Pediatric Surgery, University of Michigan, Ann Arbor, Michigan 48109-0245, USA.No 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 availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Multicenter Study
Randomized Controlled Trial

Language

eng

PubMed ID

20620323

Citation

Kim, Anne C., et al. "Endorectal Pull-through for Hirschsprung's Disease-a Multicenter, Long-term Comparison of Results: Transanal Vs Transabdominal Approach." Journal of Pediatric Surgery, vol. 45, no. 6, 2010, pp. 1213-20.
Kim AC, Langer JC, Pastor AC, et al. Endorectal pull-through for Hirschsprung's disease-a multicenter, long-term comparison of results: transanal vs transabdominal approach. J Pediatr Surg. 2010;45(6):1213-20.
Kim, A. C., Langer, J. C., Pastor, A. C., Zhang, L., Sloots, C. E., Hamilton, N. A., Neal, M. D., Craig, B. T., Tkach, E. K., Hackam, D. J., Bax, N. M., Dillon, P. A., Chamberlain, J. N., & Teitelbaum, D. H. (2010). Endorectal pull-through for Hirschsprung's disease-a multicenter, long-term comparison of results: transanal vs transabdominal approach. Journal of Pediatric Surgery, 45(6), 1213-20. https://doi.org/10.1016/j.jpedsurg.2010.02.087
Kim AC, et al. Endorectal Pull-through for Hirschsprung's Disease-a Multicenter, Long-term Comparison of Results: Transanal Vs Transabdominal Approach. J Pediatr Surg. 2010;45(6):1213-20. PubMed PMID: 20620323.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Endorectal pull-through for Hirschsprung's disease-a multicenter, long-term comparison of results: transanal vs transabdominal approach. AU - Kim,Anne C, AU - Langer,Jacob C, AU - Pastor,Aimee C, AU - Zhang,Lingling, AU - Sloots,Cornelius E J, AU - Hamilton,Nicholas A, AU - Neal,Matthew D, AU - Craig,Brian T, AU - Tkach,Erin K, AU - Hackam,David J, AU - Bax,Nicolaas M A, AU - Dillon,Patrick A, AU - Chamberlain,Jennifer N, AU - Teitelbaum,Daniel H, PY - 2010/02/13/received PY - 2010/02/22/accepted PY - 2010/7/13/entrez PY - 2010/7/14/pubmed PY - 2010/10/22/medline SP - 1213 EP - 20 JF - Journal of pediatric surgery JO - J Pediatr Surg VL - 45 IS - 6 N2 - PURPOSE: Previous 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. METHODS: Data 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). RESULTS: Two 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. CONCLUSION: Transanal 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. SN - 1531-5037 UR - https://www.unboundmedicine.com/medline/citation/20620323/Endorectal_pull_through_for_Hirschsprung's_disease_a_multicenter_long_term_comparison_of_results:_transanal_vs_transabdominal_approach_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0022-3468(10)00206-X DB - PRIME DP - Unbound Medicine ER -