A comparison between primary endorectal pull-through and staged procedures for patients with Hirschsprung’s disease

Authors

  • Reda Zbaida Tygerberg Children’s Hospital, Cape Town, South Africa
  • Corné de Vos Tygerberg Children’s Hospital, Cape Town, South Africa
  • Daniel Sidler Tygerberg Children’s Hospital, Cape Town, South Africa

DOI:

https://doi.org/10.52783/jns.v10.651

Keywords:

Hirschsprung’s disease, Primary endorectal pull-through, Staged endorectal pull-through

Abstract

Background: Primary endorectal pull-through is becoming a standard of care across the globe. This study was done to compare the outcome of patients with Hirschsprung’s disease (HD) who underwent primary endorectal pull-through with patients who were treated with a staged approach.

Methods: A retrospective data review was done of all patients diagnosed with Hirschsprung’s disease (HD) at Tygerberg Children’s Hospital, a tertiary hospital in Cape Town, during an 11-year period (2007 – 2018).  The patients were divided into 2 groups: the primary Endorectal pull-through (ERP) group and the staged group and the two groups were compared. 

Results: Eighty patients with histologically confirmed Hirschsprung’s disease (HD) were seen at our institution during the study period (2007 – 2018). Four patients did not meet the inclusion criteria and were excluded. Of the remaining seventy-six who were included, forty-six patients (60.5%) had a primary endorectal-pull through (Primary group) and thirty patients (39.5%) had staged procedures (Staged group) with a stoma before the final ERP. The peri-operative complications were subdivided into major and minor complications. Minor perioperative complications in the primary group were less (13%) compared to the staged group (33%) with a p-value of 0.017, making the difference statistically significant. Anastomotic strictures were the most common complication in both groups with abdominal wound infection being more common in the staged group. The late complications were similar in both groups with a p-value of 0.43. Constipation was the most common complication in both groups, followed by soiling. 

Conclusion: The two groups had a similar outcome without statistically significant differences. We can safely conclude that the primary endorectal pull-through for HD is at least as safe as the staged approach in Sub- Saharan Africa. With this technique, we avoid a stoma and the necessity for two surgical procedures with added potential complications.

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Author Biographies

Reda Zbaida, Tygerberg Children’s Hospital, Cape Town, South Africa

Department of Pediatric Surgery,

Corné de Vos, Tygerberg Children’s Hospital, Cape Town, South Africa

Department of Pediatric Surgery,

Daniel Sidler, Tygerberg Children’s Hospital, Cape Town, South Africa

Department of Pediatric Surgery,

References

Moore SW. Hirschsprung disease: current perspectives. Open Access Surg. 2016; 9:39-50. Available from: https://doi.org/10.2147/OAS.S81552.

Aslanabadi S, Ghaleh Golab-Behbahan A, Zarrintan S, Jamshidi M, Seyed Hejazi M. Transanal one-stage endorectal pull-through for Hirschsprung’s disease: a comparison with the staged procedures. Pediatr Surg Int. 2008; 24:925.

Wester T, Granström AL. Hirschsprung disease—Bowel function beyond childhood. Semin Pediatr Surg. [Internet]. 2017; 26:322–7. Available from: https://doi.org/10.1053/j.sempedsurg.2017.09.008.

Moore SW. Total colonic aganglionosis in Hirschsprung disease. Semin Pediatr Surg. [Internet]. 2012; 21:302–9. Available from: https://doi.org/10.1053/j.sempedsurg.2012.07.004.

De La Torre-Mondragón L, Ortega-Salgado JA. Transanal endorectal pull-through for Hirschsprung’s disease. J Pediatr Surg. [Internet]. 1998 [cited 2017 Apr 29]; 33:1283–6. Available from: http://ac.els-cdn.com.ez.sun.ac.za/S0022346898901695/1-s2.0-S0022346898901695-main.pdf?_tid=e58c83ae-2cd7-11e7-8606-00000aacb35f&acdnat=1493469324_228f20ebca53a8098a335ea3c7884b18.

Gunadi, Karina SM, Dwi Hantoro A. Outcomes in patients with Hirschsprung disease following definitive surgery. BMC Res Notes. [Internet]. 2018; 11:1–5. Available from: https://doi.org/10.1186/s13104-018-3751-5.

Al-Baghdady AA, El-Shafei EA, El-Asmar KM. One-stage transanal Swenson procedure for rectosigmoid Hirschsprung’s disease in infants and children. Ann Pediatr Surg. 2016; 12:104–8.

Onishi S, Nakame K, Yamada K, Yamada W, Kawano T, Mukai M, et al. Long-term outcome of bowel function for 110 consecutive cases of Hirschsprung’s disease: Comparison of the abdominal approach with transanal approach more than 30 years in a single institution – is the transanal approach truly beneficial for bowel function. J Pediatr Surg. [Internet]. 2016; 51:2010–4. Available from: https://doi.org/10.1016/j.jpedsurg.2016.09.029.

Ruttenstock E, Puri P. Systematic review and meta-analysis of enterocolitis after one-stage transanal pull-through procedure for Hirschsprung’s disease. Pediatr Surg Int. 2010; 1101–5.

Martínez-Criado Y, Cabrera R, Moya MJ, Valladares JC, López-Alonso M, De Agustín Asensio JC. Results of transanal endorectal descent in Hirschprung’s disease. Cirugía Española. 2015; 93:561–6.

Teitelbaum DH, Cilley RE, Sherman NJ, Bliss D, Uitvlugt ND, Renaud EJ, et al. A decade of experience with the primary pull-through for Hirschsprung disease in the newborn period: A multicenter analysis of outcomes. Ann Surg. 2000; 232:372–80.

Mk S, Sherchan M, Bg D, Rb B. Early experience with single-stage transanal endorectal. J Nepal Paediatr Soc. 2014; 34:188-94.

Zimmer J, Tomuschat C, Puri P. Long-term results of transanal pull-through for Hirschsprung’s disease: a meta-analysis. Pediatr Surg Int. [Internet]. 2016 [cited 2018 Apr 2]; 32:743–9. Available from: http://link.springer.com/10.1007/s00383-016-3908-z.

To W, Toilet B, Child Y, Started G. Toilet training guidelines: Parents-the role of the parents in toilet training. Pediatr. [Internet]. 1999; 103:1362–3. Available from: http://www.ncbi.nlm.nih.gov/pubmed/10353955.

De La Torre L, Langer JC. Transanal endorectal pull-through for Hirschsprung disease: technique, controversies, pearls, pitfalls, and an organized approach to the management of postoperative obstructive symptoms. Semin Pediatr Surg. [Internet]. 2010; 19:96–106. Available from: https://doi.org/10.1053/j.sempedsurg.2009.11.016.

Ghorbanpour M, Seyfrabie MA, Yousefi B. Early and long-term complications following transanal pull through Soave technique in infants with Hirschsprung’s disease. Med Pharm Rep.2019; 92:382–6.

Avansino JR, Levitt MA. Hirschsprung disease [Internet]. 7th ed. Fundamentals of Pediatric Surgery, Second Edition. Elsevier Inc.; 2016. 513–524 p. Available from: https://doi.org/10.1016/B978-0-323-07255-7.00101-X.

Langer JC, Rollins MD, Levitt M, Gosain A, de la Torre L, Kapur RP, et al. Guidelines for the management of postoperative obstructive symptoms in children with Hirschsprung disease. Pediatr Surg Int. 2017; 33:523–6.

Pratap A, Gupta DK, Shakya VC, Adhikary S, Tiwari A, Shrestha P, et al. Analysis of problems, complications, avoidance and management with transanal pull-through for Hirschsprung disease. J Pediatr Surg. 2007; 42:1869–76.

Rouzrokh M, Khaleghnejad AT, Mohajerzadeh L, Heydari A, Molaei H. What is the most common complication after one-stage transanal pull-through in infants with Hirschsprung’s disease? Pediatr Surg Int. 2010; 26:967–70.

El-sawaf MI, Drongowski RA, Chamberlain JN, Coran AG, Teitelbaum DH. Are the long-term results of the transanal pull-through equal to those of the transabdominal pull-through ? A comparison of the 2 approaches for Hirschsprung disease. J Pediatr Surg. 2007; 42:41–7.

Neuvonen MI, Kyrklund K, Lindahl HG, Koivusalo AI, Rintala RJ, Pakarinen MP. A population-based, complete follow-up of 146 consecutive patients after transanal mucosectomy for Hirschsprung disease. J Pediatr Surg. [Internet]. 2015; 50:1653–8. Available from: https://doi.org/10.1016/j.jpedsurg.2015.02.006.

Romero P, Kroiss M, Chmelnik M, Königs I, Wessel LM, Holland-Cunz S. Outcome of transanal endorectal vs. transabdominal pull-through in patients with Hirschsprung’s disease. Langenbecks Arch Surg. [Internet]. 2011 [cited 2018 Oct 17]; 396:1027–33. Available from: http://link.springer.com/10.1007/s00423-011-0804-9.

Kim AC, Langer JC, Pastor AC, Zhang L, Sloots CEJ, Hamilton NA, et al. Endorectal pull-through for Hirschsprung’s disease-a multicenter, long-term comparison of results: transanal vs transabdominal approach. J Pediatr Surg. [Internet]. 2010 [cited 2018 Mar 6]; 45:1213–20. Available from: https://www-clinicalkey-com.ez.sun.ac.za/#!/content/journal/1-s2.0-S002234681000206X.

Stensrud KJ, Emblem R, Bjørnland K. Functional outcome after operation for Hirschsprung disease-transanal vs transabdominal approach. J Pediatr Surg. [Internet]. 2010; 45:1640–4. Available from: https://doi.org/10.1016/j.jpedsurg.2010.02.065.

De la Torre L, Ortega A. Transanal versus open endorectal pull-through for Hirschsprung’s disease. J Pediatr Surg. 2000; 35:1630–2.

Fitzgerald PG, Winthrop AL, Skinner MA, Ternberg JL, Lau GYP, Foglia P. One-stage versus two-stage Soave pull-through for Hirschsprung’s Disease in the first year of life. J Pediatr Surg. 1996; 31:33-7.

Bjørnland K, Pakarinen MP, Stenstrøm P, Stensrud KJ, Neuvonen M, Granström AL, et al. A Nordic multicenter survey of long-term bowel function after transanal endorectal pull-through in 200 patients with rectosigmoid Hirschsprung disease. J Pediatr Surg. [Internet]. 2017; 52:1458–64. Available from: https://doi.org/10.1016/j.jpedsurg.2017.01.001.

Chung PHY, Wong KKY, Leung JL, Tam PKH, Chung KLY, Leung MWY, et al. Clinical and manometric evaluations of anorectal function in patients after transanal endorectal pull-through operation for Hirschsprung’s disease: A multicentre study. Surg Pract. 2015; 19:113–9.

Ladi-seyedian S, Shari L, Manouchehri N, Ashjaei B. A comparative study of transcutaneous interferential electrical stimulation plus behavioral therapy and behavioral therapy alone on constipation in postoperative Hirschsprung disease children. J Pediatr Surg. 2017; 52:177–83.

Puri P, Gosemann JH. Variants of Hirschsprung disease. Semin Pediatr Surg. [Internet]. 2012; 21:310–8. Available from: https://doi.org/10.1053/j.sempedsurg.2012.07.005.

Meinds RJ, Eggink MC, Heineman E, Broens PMA. Dyssynergic defecation may play an important role in postoperative Hirschsprung’s disease patients with severe persistent constipation: Analysis of a case series. J Pediatr Surg. [Internet]. 2014; 49:1488–92. Available from: https://doi.org/10.1016/j.jpedsurg.2014.05.001.

Gunnarsdóttir A, Larsson LT, Arnbjörnsson E. Transanal endorectal vs. Duhamel pull-through for Hirschsprung’s disease. Eur J Pediatr Surg. 2010; 20:242–6.

Tannuri ACA, Tannuri U, Romão RLP. Transanal endorectal pull-through in children with Hirschsprung’s disease-technical refinements and comparison of results with the Duhamel procedure. J Pediatr Surg. [Internet]. 2009; 44:767–72. Available from: https://doi.org/10.1016/j.jpedsurg.2008.08.002.

van Leeuwen K, Geiger JD, Barnett JL, Coran AG, Teitelbaum DH. Stooling and manometric findings after primary pull-throughs in Hirschsprung’s disease: Perineal versus abdominal approaches. J Pediatr Surg. [Internet]. 2002 [cited 2018 Oct 17]; 37:1321–5. Available from: https://www.sciencedirect.com/science/article/pii/S0022346802000878.

De L, Cogley K, Santos K, Morales O, Calisto J. The anal canal is the fine line between “fecal incontinence and colitis” after a pull-through for Hirschsprung disease. J Pediatr Surg. [Internet]. 2017; 52:2011–7. Available from: https://doi.org/10.1016/j.jpedsurg.2017.08.040.

Bischoff A, Frischer J, Leslie J, Dickie B, Levitt MA, Holder M, et al. Damaged anal canal as a cause of fecal incontinence after surgical repair for Hirschsprung disease – a preventable and under-reported complication. J Pediatr Surg. 2017; 52:549–53. Available from: https://doi.org/10.1016/j.jpedsurg.2016.08.027.

Levitt MA, Martin CA, Olesevich M, Bauer CL, Jackson LE, Peña A. Hirschsprung disease and fecal incontinence : diagnostic and management strategies. J Pediatr Surg. 2009; 44:271–7. Available from: https://doi.org/10.1016/j.jpedsurg.2008.10.053.

Hyman PE. Defecation disorders after surgery for Hirschsprung’s disease. J Pediatr Gastroenterol Nutr. 2005; 41:S62-3.

Zhang SC, Bai YZ, Wang W, Wang WL. Stooling patterns and colonic motility after transanal one-stage pull-through operation for Hirschsprung’s disease in children. J Pediatr Surg. 2005; 40:1766–72.

Lu C, Xie H, Li H, Geng Q, Chen H, Mo X, et al. Feasibility and efficacy of home rectal irrigation in neonates and early infancy with Hirschsprung disease. Pediatr Surg Int [Internet]. 2019; 35:1245–53. Available from: https://doi.org/10.1007/s00383-019-04552-8.

Vũ PA, Thiȩ̂n HH, Hiȩ̂p PN. Transanal one-stage endorectal pull-through for Hirschsprung disease: Experiences with 51 newborn patients. Pediatr Surg Int. 2010; 26:589–92.

Ekenze SO, Ngaikedi C, Obasi AA. Problems and outcome of Hirschsprung’s disease presenting after 1 year of age in a developing country. World J Surg. 2011; 35:22–6.

Stensrud KJ, Emblem R, Bjornland K. Late diagnosis of Hirschsprung disease - Patient characteristics and results. J Pediatr Surg. [Internet]. 2012; 47:1874–9. Available from: https://doi.org/10.1016/j.jpedsurg.2012.04.022.

Published

2021-02-12

How to Cite

1.
Zbaida R, de Vos C, Sidler D. A comparison between primary endorectal pull-through and staged procedures for patients with Hirschsprung’s disease. J Neonatal Surg [Internet]. 2021Feb.12 [cited 2025Jun.19];10:11. Available from: https://jneonatalsurg.com/index.php/jns/article/view/651

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