Transanal endorectal pull-through for Hirschsprung's disease: A comparison with the open technique

Aim: To evaluate the indications, results, and complications of Transanal Endorectal Pull-Through (TEPT) in the management of rectosigmoid Hirschsprung's disease (HD) compared with the open technique. Patients and Methods: Between November 1998 and March 2002, 68 Transanal Endorectal Pull-Through (TEPT) procedures were performed in infants and children. The patients' ages ranged from 6 days to 13 years. The primary diagnosis in all 68 patients was Hirschsprung's disease confined to the rectosigmoid region. All children were operated without construction of a pre-operative colostomy except for one patient. Follow-up period ranged from 6-46 months (mean 32 months). These patients were compared with fifty patients who had undergone open pull-through for HD during the period from November 1995 to October 1998. Results and Complications: For the TEPT group, the mean operating time was 90 min and the average length of resected bowel was 25 cm. Sixty-two patients had satisfactory results without complications. Blood transfusion was needed in eleven patients only. Recovery was very fast and patients were often hungry within 24 hours. Feeding was resumed within 48 hours. One patient required laparotomy during the procedure due to injury to the urethra. Two patients required colostomy 3 and 5 days after surgery because of delayed leakage. Three patients suffered from attacks of enterocolitis 6-9 months postoperatively. There was increased frequency of defecation (5-15 times daily) for 4-6 weeks after surgery in all patients. There was no constipation, no incontinence, no cuff abscess and no mortality in any of the patients. Average frequency of defecation was 1-3 times daily after 3 months postoperatively. For the open technique group, mean operating time was 150 min, the length of the average resected segment was 29 cm. Forty-one patients had satisfactory results without complications. The cost of the open technique was almost double that of the TEPT (6300 vs. 3200 pounds). Conclusions: Transanal Endorectal Pull-Through (TEPT) is characterized by a shorter operating time, less bleeding, shorter hospital stay, less morbidity and earlier recovery than similar open pull-through procedures. The hazards and morbidities associated with laparotomy and colostomy may be avoided with a one-stage technique in Hirschsprung's disease confined to the rectosigmoid area (70-80%). Careful long-term follow-up is required to assess continence and sexual function.