[Outcomes and defecation after one-stage transanal endorectal pull-through procedure for Hirschsprung disease]

To evaluate the efficacy, safety, and defecation after one-stage transanal endorectal pull-through(TOSEPT) for Hirschsprung disease.

Clinical data of 56 patients with Hirschsprung disease undergoing TOSEPT in the Third Hospital of Guangzhou Medical College between 2005 and 2011 were retrospectively analyzed. According to age at operation, the patients were divided into newborn group(n=21, surgery performed within 1 month after birth) and non-newborn group(n=35). Recovery period was defined as the period required for normal defecation pattern after operation. Intraoperative and postoperative parameters were compared.

The mean operative time was(121.5±39.2) minutes. The mean length of bowel resection was(17.6±4.2) cm. The mean intraoperative blood loss was(34.6±5.2) ml. The mean postoperative hospital stay was(7.2±3.6) days. Postoperative complication occurred in 6 patients(4 had enteritis and 2 had recurrent constipation) in whom 1 were considered as failure of TOSEPT because of redo-surgery or persistent problems in defecation. The remaining 53 patients had normal defecation pattern after(9.2±5.8) weeks of postoperative recovery period. Neonatal cases had significantly shorter operative time and postoperative hospital stay, and longer postoperative recovery period than non-neonatal cases(P<0.05). There were no significant differences in intraoperative blood loss and postoperative complication rate between the two groups(P>0.05).

TOSEPT is effective and safe in the management of patients with Hirschsprung disease. However, a postoperative recovery period is required for a normal defecation pattern. Although neonatal cases have significantly shorter operative time and postoperative hospital stay than non-neonatal cases, but longer postoperative recovery period should be consider when evaluating the outcome of TOSEPT.