Rectal mucosal dissection commencing directly on the anorectal line versus commencing above the dentate line in laparoscopy-assisted transanal pull-through for Hirschsprung's disease: Prospective medium-term follow-up

Background: In 2007, we began using the anorectal line (ARL) as the landmark for commencing rectal mucosal dissection (RMD) instead of the dentate line (DL) during laparoscopy-assisted transanal pull-through (L-TAPT) for Hirschsprung's disease (HD). We conducted a medium-term prospective comparison of postoperative fecal continence (POFC) between DL and ARL cases to follow our short-term study. Methods: POFC is assessed by scoring frequency of motions, severity of staining, severity of perianal erosions, anal shape, requirement for medications, sensation of rectal fullness, and ability to distinguish flatus from stool on a scale of 0 to 2 (maximum: 14). Results: Patient demographics were similar for ARL (2007-2014: n = 33) and L (1997-2006: n = 41). There were no intraoperative complications and 2 cases of postoperative colitis in both ARL (6.1%) and DL (4.9%). Mean annual medium-term POFC scores for the 4-7 term of this study were consistently better in ARL: 9.7 +/- 1.4*, 10.1 +/- 1.6*, 10.6 +/- 1.6, and 11.3 +/- 1.4* in ARL and 8.6 +/- 1.5, 9.1 +/- 1.6, 9.8 +/- 1.9, 10.0 +/- 1.6 in DL (*: p < 0.05). Conclusions: Medium-term POFC is better when the ARL is used as the landmark for RMD during L-TAPT for HD. (c) 2015 Elsevier Inc. All rights reserved.