Outcome of transanal endorectal pull-through in patients with Hirschsprung's disease

Various outcomes following transanal endorectal pull-through (TERPT) in patients with Hirschsprung's disease (HD) have been reported. In this study, the postoperative course and functional outcome after TERPT in 25 patients with HD is evaluated.

Patient records of children who underwent TERPT for HD between 2002 and 2007 were reviewed retrospectively. Age at surgery, sex, associated malformations, length of follow-up, presence of colostomy, indication for laparotomy, length of the aganglionic segment, result of rectal examination under general anaesthesia 6 weeks after surgery, necessity of a dilatation program or reoperation were investigated. In addition, standardised interviews were performed to collect the following data: bowel movement per day, faecal continence in potty-trained children or in patients older than 3 years, incidence of diarrhoea or problems with micturition and the necessity for laxative therapy.

Between 2002 and 2007, 25 patients underwent TERPT for HD. Median age at the time of surgery was 3.5 months. Median follow-up was 35 months. Calibration of the anus showed a normal age-related diameter of the anus in 12/20 children and a markedly reduced diameter in 8/20 children at 6 weeks postoperatively. Seven of the latter children underwent a dilatation program. A redo pull-through procedure was performed in 3 patients due to stenosis at the colo-anal anastomosis (n=1), a constricting muscle cuff (n=1) and a twisted pull-through (n=1). Two children developed enterocolitis. The median frequency of bowel movements was 3/day (1-5/day). Laxative treatment was required in only one patient (4.5%). None of the patients had diarrhoea. Nineteen children (86%) were potty-trained, being older than 3 years. Eighteen of them were continent (95%). One patient (5%) with trisomy 21 suffered from intermittent non-retentive faecal incontinence. None of the patients showed signs of neurogenic bladder dysfunction.

The functional outcome in most patients after TERPT is satisfactory. We suggest that routine rectal digital examination and anal calibration under anaesthesia 6 weeks postoperatively might detect occult anodermal stenosis and allow early initiation of an anorectal dilatation program, which could decrease the incidence of enterocolitis, persistent constipation and the necessity for further surgical intervention.