Transanal Endorectal Pull-through for Hirschsprung's Disease During the First Month of Life

Background/Purpose: Hirschsprung's disease (HD) is a common cause of bowel obstruction in the newborn period. One-stage surgery for HD is well established and the results are comparable or better than multistage surgery. The aim of this study was to test the feasibility and safety of transanal endorectal pull-through (TEPT) for management of HD during the neonatal period. Materials & Methods: twenty eight neonates having HD were treated with TEPT at pediatric surgery unit, Mansoura University Children's Hospital (MUCH) during the period from May 2007 to Jun 2009. Six cases were in need for concomitant laparotomy due to long segment disease. Endorectal mucosectomy was started one cm. above dentate line and continued till the peritoneal reflection. The affected bowel was resected and colo-anal anastomosis was performed with 4/0 absorbable sutures. Results: The mean operative time was 90 +/- 18 minutes. Blood transfusion was not needed. Oral feeding started 24-48 hours postoperatively and the mean hospital stay was 3-5 days. The commonest postoperative complication was perianal excoriations (64.3%), anastomotic leak occurred in one case. Two cases were in need for repeated dilatations while 4 cases presented with postoperative enterocolitis (EC). Conclusion: TEPT during the neonatal period is easy, bloodless, without visible scar and with short intraoperative time and postoperative hospital stay.