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Transanal one-stage endorectal pull-through for Hirschsprung's disease: a multicenter study
Essam A Elhalaby1, A Hashish, M M Elbarbary
1Department of Pediatric Surgery, Tanta University, Tanta, Egypt.
Insights
The one-stage transanal endorectal pull-through (TEPT) is a safe and effective surgical treatment for Hirschsprung
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Colorectal Surgery
Background:
- Hirschsprung's disease (HD) is a congenital condition affecting the large intestine.
- The transanal endorectal pull-through (TEPT) is a minimally invasive surgical approach for HD.
- Evaluating the safety and efficacy of the one-stage TEPT is crucial for pediatric surgical management.
Purpose of the Study:
- To assess the safety and efficacy of the one-stage transanal endorectal pull-through (TEPT) procedure.
- To evaluate functional outcomes and complications in children undergoing TEPT for Hirschsprung's disease.
- To determine the feasibility of the one-stage TEPT in a multi-center setting.
Main Methods:
- A prospective study involving 149 children with Hirschsprung's disease.
- All patients underwent a one-stage TEPT procedure across five Egyptian academic centers.
- Follow-up data, including functional results and complications, were collected for a median of 12 months.
Main Results:
- The one-stage TEPT procedure was performed successfully in most patients, with a mean operating time of 120.2 minutes.
- Postoperative complications included enterocolitis (26 patients) and transient perianal excoriation (48 patients).
- Complete anorectal continence was achieved in 83.3% of children over 3 years old.
Conclusions:
- The one-stage TEPT technique is a feasible and safe option for selected children with rectosigmoid Hirschsprung's disease.
- The procedure is easily learned and associated with excellent clinical outcomes.
- TEPT offers a promising surgical solution for managing Hirschsprung's disease across all age groups.
Background/Purpose:
Transanal endorectal pull-through (TEPT) is the latest development in treatment of Hirschsprung's disease (HD). This prospective study was designed to evaluate the safety and efficacy of 1 stage TEPT technique in the management of patients with HD.
Methods:
One hundred forty-nine children (116 boys and 33 girls) aged 8 days to 14 years underwent 1 stage TEPT procedure over an 18-month period at 5 Egyptian academic pediatric surgical centers and affiliated hospitals. Median follow-up was 12 months (range, 3 to 21 months). These patients were evaluated with regard to age, sex, length of the aganglionic segment, intraoperative details, and postoperative functional results or complications. An electromyogram (EMG), endorectal ultrasound scan, and lower gastrointestinal (GI) motility studies were reserved for patients with postoperative problems with bowel control.
Results:
Mean operating time was 120.2 +/- 27.8 minutes (range, 60 to 210 minutes). The average length of resected bowel was 26.8 +/- 12.4 cm (range, 15 to 45 cm). Thirteen patients required laparotomy because of extension of aganglionic segment beyond the sigmoid colon in 9, tear in the mesenteric vessels in 2, and difficulties in getting to the submucosal plane in 2. Three deaths (2%) occurred 3 days, 4 days, and 4 weeks postoperatively, respectively. Postoperative complications included transient perianal excoriation in 48 patients (30 were <3 months of age), enterocolitis (n = 26), anastomotic stricture (n = 7), recurrent constipation (n = 6), hypoganglionosis at distal end of pulled through segment (n = 2), cuff abscess (n = 3), anastomotic leak (n = 1), adhesive bowel obstruction (n = 1), and rectal prolapse (n = 1). Complete anorectal continence was noted in 35 of 42 (83.3%) children older than 3 years, whereas soiling and frequent accidents still occur in 7, who showed a steady improvement in their continence status.
Conclusions:
One-stage TEPT technique is both feasible and safe technique in properly selected children with rectosigmoid HD in all ages. The technique is easily learned and is associated with excellent clinical results.
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