Ju Yeon Lee; Jung Hyun Choi; Jung-Man Namgung; Dae Yeon Kim; Sung-Cheol Kim

doi:10.13029/jkaps.2016.22.2.38

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Lee, Choi, Namgung, Kim, and Kim: Single Stage Transanal Endorectal Pull-through Operation for Hirschsprung’s Disease in Neonate: A Single Center Experience

Original Article

Journal of the Korean Association of Pediatric Surgeons 2016; 22(2): 38-41.

Published online: 22 December 2016

DOI: https://doi.org/10.13029/jkaps.2016.22.2.38

Single Stage Transanal Endorectal Pull-through Operation for Hirschsprung’s Disease in Neonate: A Single Center Experience

Ju Yeon Lee^1,², Jung Hyun Choi^1,², Jung-Man Namgung^1,², Dae Yeon Kim^1,², Sung-Cheol Kim^1,²

¹Department of Surgery, University of Ulsan College of Medicine, Seoul, Korea.

²Department of Pediatric Surgery, Asan Medical Center Children’s Hospital, Seoul, Korea.

Correspondence: Dae Yeon Kim, Department of Pediatric Surgery, Asan Medical Center Children’s Hospital, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea. Tel: +82-2-3010-3961, Fax: +82-2-3010-6863, kimdy@amc.seoul.kr

Received 29 June 2016 Revised 17 October 2016 Accepted 18 October 2016

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

The single stage transanal pull-through (SSPT) for Hirschsprung’s disease is becoming the most popular procedure. This single center study compared the result of single stage operation with two-stage operation for Hirschsprung’s disease in neonates.

Methods

We retrospectively reviewed medical records of all patients who were diagnosed as Hirschsprung’s disease and underwent SSPT or two-stage operation operation in Asan Medical Center between January 2003 and July 2014.

Results

There were 17 SSPT and 28 two-stage operation. The mean age of SSPT group was 14.2±7.1 days, and the mean age of two-stage operation group was 15.4±8.6 days for stomy formation, and 188.6±36.3 days for Duhamel operation. The operation time of SSPT was shorter than Duhamel operation (145.0±37.0 minutes vs. 193.0±36.0 minutes, p<0.001). The mean follow-up period of SSPT and two-stage operation was 35.5±34.9 months (range, 2-132 months) and 56.6±35.5 months (range, 1-121 months), respectively. Defecation problem rate such as fecal soiling or fecal impaction showed no significant difference between the two groups (p=0.719). Two SSPT patients required botulinum toxin injection due to rectal stenosis. Three patients of SSPT group underwent re-do endorectal pull-through due to remnant aganglionic or hypoganglionic bowel.

Conclusion

The SSPT showed shorter hospital days. However, few patients experienced rectal stenosis, but were manageable with botulinum toxin injection. The SSPT requires experienced-pathologist, as well as surgeon, because intra-operation pathology reading is critical for appropriate SSPT. SSPT is a feasible and reasonable option to treat Hirschsprung’s disease.

Keywords: Hirschsprung disease, Transanal pull-through, Single stage surgery, Newborn infant

Figures and Tables

Table 1

Demographics of Patients

Values are presented as n only or mean±SD.

SSPT, single stage transanal endorectal pull-through; S, stomy formation; D, Duhamel operation; M, male; F, female; LR, lower rectum; UR, upper rectum; RSJ, rectosigmoid junction; SC, sigmoid colon; DC, descending colon; MR, mid-rectum.

Table 2

Result of the Procedure

Values are presented as mean±SD or n only.

SSPT, single stage transanal endorectal pull-through; S, stomy formation; D, Duhamel operation; POD, postoperative day.

Notes

^{CONFLICTS OF INTEREST} No potential conflict of interest relevant to this article was reported.

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