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Transanal endorectal pull-through for Hirschsprung's disease using long cuff dissection and short V-shaped partially resected cuff anastomosis: early and late outcomes.
Pediatr Surg Int. 2012 May; 28(5):515-21.PS

Abstract

BACKGROUND

Transanal endorectal pull-through was described by De la Torre-Mondragon's technique. In the original transanal pull-through procedure, a long rectal muscular cuff was dissected and left for anocolic anastomosis, which would sometimes lead to postoperative obstructive symptoms and enterocolitis. While a modified short mucosal dissection may increase the risk of injury to pelvic and perirectal nerves and other structures when dissected on the outside of the rectum deep in the pelvis. We report early and late results of the modified transanal procedure for Hirschsprung's disease (HD) over 8 years.

METHODS

The clinical course of all children with aganglionic rectum or sigmoid colon receiving the modified transanal pull-through between May 2003 and April 2011 were reviewed. The main modifications were rectal mucosa dissection with a long cuff, coloanal anastomosis with a short cuff and a V-shaped partial resection in the posterior wall of the muscular cuff. Children with preliminary stoma or total colonic disease were excluded.

RESULTS

Short- and long-term follow-up was obtained in 137 patients with HD operated upon by the same surgeon. The aganglionic segment was located in the rectum or sigmoid colon in all patients. The mean age at surgery was 165 ± 74 days. The mean operating time was 108 ± 38 min. Mean intra-operative blood loss was estimated to be 15 ± 10 ml. No patient required a blood transfusion. Mean postoperative hospital stay was 7 ± 2 days. Early postoperative complications included perianal excoriation in 38 patients (27.7 %), enterocolitis in two patients (1.4 %), and anastomotic leak in two patients (1.4 %). Late postoperative complications included perianal excoriation in 16 patients (11.7 %), anal stricture in two patients (1.4 %), constipation in four patients (2.8 %), enterocolitis in 10 patients (7.3 %), and soiling problems in six patients (4.4 %). Mean follow-up was 56 months (6 months-9 years). In patients older than 4 years, 85.4 % of them had excellent/good bowel function, 9.4 % had fair bowel function, and 5.2 % of patients had bad bowel function.

CONCLUSION

Transanal endorectal pull-through with a long cuff dissection and a short V-shaped resected cuff anastomosis is a safe and effective procedure for HD. It reduced incidence of anastomotic stricture and constipation without an increased soiling incidence.

Authors+Show Affiliations

Department of Pediatric Surgery, Union Hospital of Huazhong University of Science and Technology, Wuhan, 430022, China.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 available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

22426598

Citation

Yang, Li, et al. "Transanal Endorectal Pull-through for Hirschsprung's Disease Using Long Cuff Dissection and Short V-shaped Partially Resected Cuff Anastomosis: Early and Late Outcomes." Pediatric Surgery International, vol. 28, no. 5, 2012, pp. 515-21.
Yang L, Tang ST, Cao GQ, et al. Transanal endorectal pull-through for Hirschsprung's disease using long cuff dissection and short V-shaped partially resected cuff anastomosis: early and late outcomes. Pediatr Surg Int. 2012;28(5):515-21.
Yang, L., Tang, S. T., Cao, G. Q., Yang, Y., Li, S., Li, S. W., Wang, Y., Mao, Y. Z., Ruan, Q. L., & Wang, G. B. (2012). Transanal endorectal pull-through for Hirschsprung's disease using long cuff dissection and short V-shaped partially resected cuff anastomosis: early and late outcomes. Pediatric Surgery International, 28(5), 515-21. https://doi.org/10.1007/s00383-012-3071-0
Yang L, et al. Transanal Endorectal Pull-through for Hirschsprung's Disease Using Long Cuff Dissection and Short V-shaped Partially Resected Cuff Anastomosis: Early and Late Outcomes. Pediatr Surg Int. 2012;28(5):515-21. PubMed PMID: 22426598.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Transanal endorectal pull-through for Hirschsprung's disease using long cuff dissection and short V-shaped partially resected cuff anastomosis: early and late outcomes. AU - Yang,Li, AU - Tang,Shao-Tao, AU - Cao,Guo-Qing, AU - Yang,Ying, AU - Li,Shuai, AU - Li,Shi-Wang, AU - Wang,Yong, AU - Mao,Yong-Zhong, AU - Ruan,Qing-Lan, AU - Wang,Guo-Bin, Y1 - 2012/03/20/ PY - 2012/03/05/accepted PY - 2012/3/20/entrez PY - 2012/3/20/pubmed PY - 2012/8/14/medline SP - 515 EP - 21 JF - Pediatric surgery international JO - Pediatr Surg Int VL - 28 IS - 5 N2 - BACKGROUND: Transanal endorectal pull-through was described by De la Torre-Mondragon's technique. In the original transanal pull-through procedure, a long rectal muscular cuff was dissected and left for anocolic anastomosis, which would sometimes lead to postoperative obstructive symptoms and enterocolitis. While a modified short mucosal dissection may increase the risk of injury to pelvic and perirectal nerves and other structures when dissected on the outside of the rectum deep in the pelvis. We report early and late results of the modified transanal procedure for Hirschsprung's disease (HD) over 8 years. METHODS: The clinical course of all children with aganglionic rectum or sigmoid colon receiving the modified transanal pull-through between May 2003 and April 2011 were reviewed. The main modifications were rectal mucosa dissection with a long cuff, coloanal anastomosis with a short cuff and a V-shaped partial resection in the posterior wall of the muscular cuff. Children with preliminary stoma or total colonic disease were excluded. RESULTS: Short- and long-term follow-up was obtained in 137 patients with HD operated upon by the same surgeon. The aganglionic segment was located in the rectum or sigmoid colon in all patients. The mean age at surgery was 165 ± 74 days. The mean operating time was 108 ± 38 min. Mean intra-operative blood loss was estimated to be 15 ± 10 ml. No patient required a blood transfusion. Mean postoperative hospital stay was 7 ± 2 days. Early postoperative complications included perianal excoriation in 38 patients (27.7 %), enterocolitis in two patients (1.4 %), and anastomotic leak in two patients (1.4 %). Late postoperative complications included perianal excoriation in 16 patients (11.7 %), anal stricture in two patients (1.4 %), constipation in four patients (2.8 %), enterocolitis in 10 patients (7.3 %), and soiling problems in six patients (4.4 %). Mean follow-up was 56 months (6 months-9 years). In patients older than 4 years, 85.4 % of them had excellent/good bowel function, 9.4 % had fair bowel function, and 5.2 % of patients had bad bowel function. CONCLUSION: Transanal endorectal pull-through with a long cuff dissection and a short V-shaped resected cuff anastomosis is a safe and effective procedure for HD. It reduced incidence of anastomotic stricture and constipation without an increased soiling incidence. SN - 1437-9813 UR - https://www.unboundmedicine.com/medline/citation/22426598/Transanal_endorectal_pull_through_for_Hirschsprung's_disease_using_long_cuff_dissection_and_short_V_shaped_partially_resected_cuff_anastomosis:_early_and_late_outcomes_ L2 - https://doi.org/10.1007/s00383-012-3071-0 DB - PRIME DP - Unbound Medicine ER -