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Published on: April 26, 2019
One-stage transanal Soave pullthrough for Hirschsprung disease: a multicenter experience with 141 children
Jacob C Langer1, Audrey C Durrant, Luis de la Torre
1Department of Surgery, University of Toronto, Toronto, Ontario, Canada. jacob.langer@sickkids.ca
Insights
The one-stage transanal Soave pullthrough is a safe and effective surgical option for Hirschsprung
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Surgical Innovation
Background:
- Hirschsprung's disease (HD) management has evolved, moving towards minimally invasive single-stage procedures.
- The transanal Soave pullthrough represents a significant advancement in surgical techniques for HD.
Purpose of the Study:
- To evaluate the early outcomes of the one-stage transanal Soave pullthrough procedure for Hirschsprung's disease.
- To assess the safety, efficacy, and complication rates of this minimally invasive approach.
Main Methods:
- A retrospective review of 141 children with HD undergoing a one-stage transanal Soave pullthrough between 1995 and 2002.
- Exclusion criteria included preliminary stoma or total colonic disease.
Main Results:
- The procedure demonstrated minimal blood loss (16 mL) and no transfusions required.
- Patients experienced early feeding (36 hours), short hospital stays (3.4 days), and low pain scores.
- Early complications included perianal excoriation (11%), enterocolitis (6%), and stricture (4%).
- At a mean follow-up of 20 months, 81% had normal bowel function, with a low rate of major complications (1%).
Conclusions:
- The one-stage transanal Soave pullthrough is a safe and effective surgical option for Hirschstrung's disease.
- This approach facilitates early feeding, discharge, and has a low complication rate.
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.
