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Transanal rectal mucosectomy and partial internal anal sphincterectomy for Hirschsprung's disease.
J Pediatr Surg. 2014 May; 49(5):831-4.JP

Abstract

PURPOSE

Hirschsprung-associated enterocolitis (HAEC) is a serious complication of Hirschsprung's disease (HD), with generalized sepsis and high mortality rate. Although the surgical correction of HD is mostly successful, challenges remain in the management of children with repeated episodes of enterocolitis. The authors describe a novel modification of transanal rectal mucosectomy and partial internal anal sphincterectomy (TRM-PIAS) for HD.

METHODS

One hundred twenty-seven HD children aged from 8 days to 16 years who successfully underwent TRM-PIAS were reviewed. TRM-PIAS was carried out circumferentially along the anorectal line. Anterior dissection was conducted between the rectal submuscosal layer and the rectal muscular sleeve. The posterior dissection was performed along the plane between internal and external anal sphincters. Normal colon was pulled through and anastomosed to anal mucosa. Aganglionic segment, rectal mucosa, part of internal anal sphincter and posterior rectal muscular cuff were removed. Twenty-five age-matched children without defecation dysfunction were used as the control group in the study of anal resting pressure.

RESULTS

Patients were followed up for 6-12 years (median: 8.2 years). The median age at last follow-up was 12.2 years (7.2-20.1 years). The incidence of enterocolitis decreased from 33.9% (43/127) preoperatively to 1.6% (2/127) postoperatively (P<0.01). The incidence of constipation decreased from 100% (127/127) preoperatively to 2.4% (3/127) postoperatively (P<0.01). Soiling rate on postoperative 1 month was 32.3%. It gradually decreased to 1.6% 6 months later. Anorectal manometries showed that mean anal resting pressure was significantly reduced from 37.9±12.5 mm Hg preoperatively to 20.2±6.4 mm Hg on postoperative 1 month and 24.8±9.9 mm Hg on postoperative 6 months, which were similar to age-matched normal controls (27.9±9.6 mm Hg, P>0.05).

CONCLUSIONS

TRM-PIAS is effective in treatment of HD. It is associated with low postoperative HD-associated enterocolitis.

Authors+Show Affiliations

Department of Pediatric Surgery, Capital institute of Pediatrics, Beijing, China.Department of Pediatric Surgery, Capital institute of Pediatrics, Beijing, China. Electronic address: lilong23@126.com.Department of Pediatric Surgery, Capital institute of Pediatrics, Beijing, China.Department of Pediatric Surgery, Capital institute of Pediatrics, Beijing, China.Department of Pediatric Surgery, Capital institute of Pediatrics, Beijing, China.Department of Pediatric Surgery, Capital institute of Pediatrics, Beijing, China.Department of Pediatric Surgery, Capital institute of Pediatrics, Beijing, China.Department of Surgery, Beijing United Family Hospital, China; Department of Paediatrics and Surgery, Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria, Australia. Electronic address: wei.cheng@monash.edu.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

24851780

Citation

Zhang, Jin-Shan, et al. "Transanal Rectal Mucosectomy and Partial Internal Anal Sphincterectomy for Hirschsprung's Disease." Journal of Pediatric Surgery, vol. 49, no. 5, 2014, pp. 831-4.
Zhang JS, Li L, Hou WY, et al. Transanal rectal mucosectomy and partial internal anal sphincterectomy for Hirschsprung's disease. J Pediatr Surg. 2014;49(5):831-4.
Zhang, J. S., Li, L., Hou, W. Y., Liu, S. L., Diao, M., Zhang, J., Ming, A. X., & Cheng, W. (2014). Transanal rectal mucosectomy and partial internal anal sphincterectomy for Hirschsprung's disease. Journal of Pediatric Surgery, 49(5), 831-4. https://doi.org/10.1016/j.jpedsurg.2014.02.042
Zhang JS, et al. Transanal Rectal Mucosectomy and Partial Internal Anal Sphincterectomy for Hirschsprung's Disease. J Pediatr Surg. 2014;49(5):831-4. PubMed PMID: 24851780.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Transanal rectal mucosectomy and partial internal anal sphincterectomy for Hirschsprung's disease. AU - Zhang,Jin-Shan, AU - Li,Long, AU - Hou,Wen-Ying, AU - Liu,Shu-Li, AU - Diao,Mei, AU - Zhang,Jun, AU - Ming,An-Xiao, AU - Cheng,Wei, Y1 - 2014/02/17/ PY - 2013/05/27/received PY - 2014/01/26/revised PY - 2014/02/12/accepted PY - 2014/5/24/entrez PY - 2014/5/24/pubmed PY - 2015/1/6/medline KW - Children KW - Hirschsprung-associated enterocolitis KW - Hirschsprung’s disease KW - Internal anal sphincter SP - 831 EP - 4 JF - Journal of pediatric surgery JO - J. Pediatr. Surg. VL - 49 IS - 5 N2 - PURPOSE: Hirschsprung-associated enterocolitis (HAEC) is a serious complication of Hirschsprung's disease (HD), with generalized sepsis and high mortality rate. Although the surgical correction of HD is mostly successful, challenges remain in the management of children with repeated episodes of enterocolitis. The authors describe a novel modification of transanal rectal mucosectomy and partial internal anal sphincterectomy (TRM-PIAS) for HD. METHODS: One hundred twenty-seven HD children aged from 8 days to 16 years who successfully underwent TRM-PIAS were reviewed. TRM-PIAS was carried out circumferentially along the anorectal line. Anterior dissection was conducted between the rectal submuscosal layer and the rectal muscular sleeve. The posterior dissection was performed along the plane between internal and external anal sphincters. Normal colon was pulled through and anastomosed to anal mucosa. Aganglionic segment, rectal mucosa, part of internal anal sphincter and posterior rectal muscular cuff were removed. Twenty-five age-matched children without defecation dysfunction were used as the control group in the study of anal resting pressure. RESULTS: Patients were followed up for 6-12 years (median: 8.2 years). The median age at last follow-up was 12.2 years (7.2-20.1 years). The incidence of enterocolitis decreased from 33.9% (43/127) preoperatively to 1.6% (2/127) postoperatively (P<0.01). The incidence of constipation decreased from 100% (127/127) preoperatively to 2.4% (3/127) postoperatively (P<0.01). Soiling rate on postoperative 1 month was 32.3%. It gradually decreased to 1.6% 6 months later. Anorectal manometries showed that mean anal resting pressure was significantly reduced from 37.9±12.5 mm Hg preoperatively to 20.2±6.4 mm Hg on postoperative 1 month and 24.8±9.9 mm Hg on postoperative 6 months, which were similar to age-matched normal controls (27.9±9.6 mm Hg, P>0.05). CONCLUSIONS: TRM-PIAS is effective in treatment of HD. It is associated with low postoperative HD-associated enterocolitis. SN - 1531-5037 UR - https://www.unboundmedicine.com/medline/citation/24851780/Transanal_rectal_mucosectomy_and_partial_internal_anal_sphincterectomy_for_Hirschsprung's_disease_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0022-3468(14)00142-0 DB - PRIME DP - Unbound Medicine ER -