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What is the appropriate aganglionic bowel length on contrast enema for attempting single stage transanal endorectal

Bahar Ashjaei1, Afshar Ghamari Khameneh2, Neda Pak3

  • 1Department of Pediatric surgery, Pediatric center of excellence, Tehran University of Medical Sciences, Tehran, Iran.

Journal of Pediatric Surgery
|September 18, 2020
PubMed

Insights

Single-stage transanal endorectal pull-through (TERPT) is safe for Hirschsprung disease (HD) patients older than 10 months with aganglionic length under 52 cm, reducing the need for laparotomy.

Area of Science:

  • Pediatric Surgery
  • Gastroenterology
  • Colorectal Surgery

Background:

  • Hirschsprung disease (HD) is a congenital disorder characterized by the absence of ganglion cells in the distal bowel.
  • Single-stage transanal endorectal pull-through (TERPT) is a surgical approach for HD.
  • Patient selection and surgical technique are crucial for successful TERPT outcomes.

Purpose of the Study:

  • To determine the influence of patient age and abnormal bowel length on the surgical technique for single-stage TERPT in HD.
  • To identify predictive factors for operative approach in HD patients undergoing TERPT.

Main Methods:

  • Observational study over 2.5 years including children under 14 with suspected HD.
  • Contrast enema (CE) used to measure aganglionic bowel length (distance from anus to transitional zone).
  • Preoperative biopsy confirmed diagnosis; statistical analysis included t-tests, correlation, and ROC analysis.

Main Results:

  • Mean aganglionic bowel length measured 33.5 cm on CE and 56.8 cm pathologically (p < 0.01).
  • A length of 52 cm predicted laparoscopy/laparotomy need with 75% sensitivity and 85% specificity.
  • Significant differences in CE vs. pathology measurements were noted in infants < 10 months (p = .004).

Conclusions:

  • Single-stage TERPT is feasible for HD patients older than 10 months with aganglionic length < 52 cm on CE.
  • These criteria predict a low chance of requiring additional laparotomy or laparoscopy.
  • Age and bowel length are key factors in planning TERPT for HD.
Abstract

Keywords:
AganglionosisContrast enemaHirschsprungTransanal endorectal pull-through

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