The Effects Of Transanal Soave Endorectal Pull-through On Hirschsprung's Disease In Children

ObjectiveTo compare the effects of transanal Soave endorectal pull-through (TEPT) on Hirschsprung's disease in children, and to understand the correlative factors with the result. To decreased its complications.MethodsFrom September 2001 to January 2009,168 patients with HD underwent TEPT procedure, male 145, female 23, the age at operation was 15 days to 14 years (average 1.4 years).51 were <4 months of age,30 were 4-6 months of age, 33 were 7～12 months of age,54 were>13 months of age.36 cases were short-segment type, 108 cases were common type,24 were long-segment type. To compare the therapeutic effects in the perioperation, to analyze retrospectively in postoperative complications and to follow-up on the postoperative function of defecation and quality of life. Behavior problems and anorectal function of 46 children who underwent operation for Hirschsprung's disease at least 3 years ago, were investigated with Krickenbeck standard and achenbach child behavior check list (CBCL). All data was analysis in SPSS12.0 for windows software.ResultsTeatment included TEPT procedure in 168, Laparoscopic-assisted TEPT procedure in six, minilaparotomy procedure in five. The mean operating time and blood loss of <4 months old group was 97.35±32.53 minutes and 21.63±16.44ml.There was significant difference among different age groups (P<0.05). Postoperative complications included transient perianal excoriation in 48 patients, enterocolitis (n=19), cuff abscess (n=4),anastomotic stricture (n=4), recurrent constipation (n=13), anastomotic leak (n=2),hypoganglionosis at distal end of pulled through segment (n=2), rectal prolapse (n=2). strangulation of colon (n=2), no adhesive bowel obstruction, in which four patients were reoperated for recurrent constipation. Postoperative fecal function was not visible differences in various age groups. Fecal functional disorder dropped off along with delay after surgery no matter of the different operative age. The longer of postoperative time, the fewer of fecal dysfunctions. Over three years complete anorectal continence was noted in 57 of 63 (90.5%). No differences were found among patients bowel function on the age of treatment. But bowel function were different among the type of pathology. Among boys from 6 to 11 years old, the age at operation was≥30 months group (46.15%) had higher behavior problems than <30 months group (14.81%).There was great difference between those groups (χ2=4.596,P=0.032).Conclusions1. TEPT procedure is a good method for Hirschsprung's disease, especially fitful to newborns or infants younger than children.TEPT takes less operating time, has less bleeding, less complication, earlier recovery and less long-term behavior problems.2. No differences were found among patients'recent post operative complications on the type of pathology. But long-segment aganglionosis has poor fecal continence.3. The prognosis of transanal endorectal pull-through for Hirschsprung's disease are mainly related with the incised range of pathological bowel segment and muscular cuff, the age of treatment indications,indication, somatic and psychological care.