Eur J Pediatr Surg 2010; 20(4): 242-246
DOI: 10.1055/s-0030-1252006
Original Article

© Georg Thieme Verlag KG Stuttgart · New York

Transanal Endorectal vs. Duhamel Pull-Through for Hirschsprung's Disease

A. Gunnarsdóttir1 , L.-T. Larsson2 , E. Arnbjörnsson1
  • 1Lund University Hospital, Dpt of Pediatric Surgery, Lund, Sweden
  • 2Divisional manager, Div.3 Stab, Lund, Sweden
Further Information

Publication History

received September 27, 2009

accepted after revision March 01, 2010

Publication Date:
14 April 2010 (online)

Abstract

Introduction: The aim of this study was to test the hypothesis that the early functional outcome for patients with rectosigmoid Hirschsprung's disease (HD) is comparable for the Duhamel pull-through procedure and the transanal endorectal pull-through (TERPT) procedure, with less discomfort for the patient postoperatively after the TERPT technique.

Material and methods: Eleven patients operated on with the TERPT technique (T Group) were prospectively registered and compared retrospectively with 18 patients operated on with the Duhamel pull-through (D Group). Data recorded included patient demographics, operative treatment, complications, hospital stay and bowel functions. The follow-up time was limited to 24 months.

Results: The T Group started oral feeding sooner, their bowel movements started sooner and they had less need for analgesia postoperatively and a significantly shorter hospital stay. 71% of the patients in the D Group needed re-intervention compared to only 18% of the T Group. Enterocolitis was seen in two patients in both groups. At the last clinical control ten patients had constipation (59%) and three had soiling (18%) in the D Group. Three patients in the T Group had constipation (27%) and one had soiling (9%).

Conclusion: Our results support the use of the TERPT method rather than the Duhamel pull-through for rectosigmoid HD.

References

  • 1 Albanese CT, Jennings RW, Smith B. et al . Perineal one-stage pull-through for Hirschsprung's disease.  J Pediatr Surg. 1999;  34 377-380
  • 2 De la Torre L, Ortega A. Transanal versus open endorectal pull-through for Hirschsprung's disease.  J Pediatr Surg. 2000;  35 1630-1632
  • 3 De la Torre-Mondragon L, Ortega-Salgado JA. Transanal endorectal pull-through for Hirschsprung's disease.  J Pediatr Surg. 1998;  33 1283-1286
  • 4 Duhamel B. A new operation for the treatment of Hirschsprung's disease.  Arch Dis Child. 1960;  35 38-39
  • 5 Elhalaby EA, Hashish A, Elbarbary MM. et al . Transanal one-stage endorectal pull-through for Hirschsprung's disease: a multicenter study.  J Pediatr Surg. 2004;  39 345-351
  • 6 Georgeson KE, Cohen RD, Hebra A. et al . Primary laparoscopic-assisted endorectal colon pull-through for Hirschsprung's disease: a new gold standard.  Ann Surg. 1999;  229 678-682
  • 7 Hackam DJ, Superina RA, Pearl RH. Single-stage repair of Hirschsprung's disease: a comparison of 109 patients over 5 years.  J Pediatr Surg. 1997;  32 1028-1031 discussion 1031–1022
  • 8 Jester I, Holland-Cunz S, Loff S. et al . Transanal pull-through procedure for Hirschsprung's disease: a 5-year experience.  Eur J Pediatr Surg. 2009;  19 68-71
  • 9 Langer JC, Durrant AC, de la Torre L. et al . One-stage transanal Soave pullthrough for Hirschsprung's disease: a multicenter experience with 141 children.  Ann Surg. 2003;  238 569-583
  • 10 Langer JC, Seifert M, Minkes RK. One-stage Soave pull-through for Hirschsprung's disease: a comparison of the transanal and open approaches.  J Pediatr Surg. 2000;  35 820-822
  • 11 Martucciello G, Pini Prato A, Puri P. et al . Controversies concerning diagnostic guidelines for anomalies of the enteric nervous system: a report from the fourth International Symposium on Hirschsprung's disease and related neurocristopathies.  J Pediatr Surg. 2005;  40 1527-1531
  • 12 Minford JL, Ram A, Turnock RR. et al . Comparison of functional outcomes of Duhamel and transanal endorectal coloanal anastomosis for Hirschsprung's disease.  J Pediatr Surg. 2004;  39 161-165
  • 13 Pierro A, Fasoli L, Kiely EM. et al . Staged pull-through for rectosigmoid Hirschsprung's disease is not safer than primary pull-through.  J Pediatr Surg. 1997;  32 505-509
  • 14 Rescorla FJ, Morrison AM, Engles D. et al . Hirschsprung's disease. Evaluation of mortality and long-term function in 260 cases.  Arch Surg. 1992;  127 934-941
  • 15 Rintala RJ. Transanal coloanal pull-through with a short muscular cuff for classic Hirschsprung's disease.  Eur J Pediatr Surg. 2003;  13 181-186
  • 16 Tannuri AC, Tannuri U, Romao RL. Transanal endorectal pull-through in children with Hirschsprung's disease – technical refinements and comparison of results with the Duhamel procedure.  J Pediatr Surg. 2009;  44 767-772
  • 17 Teitelbaum DH, Cilley RE, Sherman NJ. et al . A decade of experience with the primary pull-through for Hirschsprung's disease in the newborn period: a multicenter analysis of outcomes.  Ann Surg. 2000;  232 372-380
  • 18 Till H, Heinrich M, Schuster T. et al . Is the anorectal sphincter damaged during a transanal endorectal pull-through (TERPT) for Hirschsprung's disease? A 3-dimensional, vector manometric investigation.  Eur J Pediatr Surg. 2006;  16 188-191
  • 19 Van Leeuwen K, Geiger JD, Barnett JL. et al . Stooling and manometric findings after primary pull-throughs in Hirschsprung's disease: Perineal versus abdominal approaches.  J Pediatr Surg. 2002;  37 1321-1325
  • 20 Wester T, Rintala RJ. Early outcome of transanal endorectal pull-through with a short muscle cuff during the neonatal period.  J Pediatr Surg. 2004;  39 157-160
  • 21 Zhang SC, Bai YZ, Wang W. et al . Clinical outcome in children after transanal 1-stage endorectal pull-through operation for Hirschsprung's disease.  J Pediatr Surg. 2005;  40 1307-1311

Correspondence

Dr. Anna GunnarsdóttirMD 

Lund University Hospital

Dpt of Pediatric Surgery

Getingevägen 2

221 85 Lund

Sweden

Phone: 0046 46178305

Fax: 0046 46172299

Email: anna.gunnarsdottir@med.lu.se