The Outcome of Transanal One-stage Pull- through Procedure for Hirschsprung Disease

ABSTRACT

PURPOSE: In the management of Hirschsprung's disease (HD), conventional Duhamel's, Swenson's or Soave's procedures have generally been performed. The author tried a new procedure, a transanal one-stage pull-through procedure (TOP). The aim of this study is to compare functional outcome of TOP with the conventional procedures that are generally used in treating HD. METHODS: Thirty-one cases received TOP procedure from November 2000 to December 2003. The postoperative results were evaluated by performing a retrospective medical record review, and by using as questionnaire. These results were then compared with reports' on patients after using one of the conventional procedures. RESULTS: In this study, the mean age of patients was 73.4 days, the mean hospital stay was 5.7 days and the mean follow-up period was 20.1 months. Postoperative results were as follows (1) 23 cases (74.2%) had 1~2 times of defecation per day. (2) 26 cases (83.9%) had no problematic soiling. (3) 22 cases (70.9%) had soft consistency of stool. (4) 24 cases (77.4%) had no straining during defecation. (5) 25 cases (80.7%) didn't need stool softner. (6) In 14 cases (45.2%), an anal dilator was necessary for transient postoperative anal stricture. (7) After 24 months of age, a diaper was not necessary in 12 cases (70.6%). (8) The parents felt satisfactory in 28 cases (90.3%) for their children, as compared with the children from other families, and the parents felt satisfactory in 18 cases (94.7%) for the HD children compared with the other children of their family.(9) 23 cases (74.2%) had not shown constipation findings on simple abdomen film. (10) At the first digital rectal examination, perianal rash was found in 13 cases (41.9%), anastomotic stricture had occurred in 12 cases (38.7%), and normal squeezing pressure was felt in 27 cases (87.1%). However, at the last examination during the follow-up period, perianal rash was found in 2 cases (6.5%), the anastomotic stricture had not persisted, and normal squeezing pressure was felt in all cases (100%). (11) On the barium study, 13 months after operation, no retention of contrast within 24 hours was shown in 21 cases (95.5%). (12) According to the SanFilippo system, there were 24 excellent cases (77.4%) and 7 good cases (22.6%), so all the cases showed a favorable functional outcome. (13) In comparison with other reports' results, there was no significant difference between the author's outcomes and other reports' outcomes (p=0.752). CONCLUSION: This transanal one-stage pull-through procedure (TOP) seems to be as effective as the traditional method for the management of HD.