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Eur J Pediatr Surg 2013; 23(02): 094-102
DOI: 10.1055/s-0033-1343085
Review
Georg Thieme Verlag KG Stuttgart · New York

Open Versus Transanal Pull-Through for Hirschsprung Disease: A Systematic Review of Long-Term Outcome

Jan-Hendrik Gosemann
1   Department of Pediatric Surgery, Hannover Medical School, Hannover, Germany
,
Florian Friedmacher
2   National Children's Research Centre, Our Lady's Children's Hospital, Crumlin, Dublin, Ireland
,
Benno Ure
1   Department of Pediatric Surgery, Hannover Medical School, Hannover, Germany
,
Martin Lacher
1   Department of Pediatric Surgery, Hannover Medical School, Hannover, Germany
› Author Affiliations
Further Information

Publication History

12 March 2013

12 March 2013

Publication Date:
09 April 2013 (online)

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Abstract

Introduction Various surgical techniques for the treatment of Hirschsprung disease (HD) have been proposed. The most relevant long-term complications of HD surgery include constipation, soiling/incontinence, enterocolitis, and anastomotic stricture. To date, there has been no randomized controlled trial evaluating the long-term outcome of OPEN surgery compared with transanal approaches with and without laparoscopy (laparoscopic-assisted transanal-endorectal pull-through [L-TERPT] and transanal-endorectal pull-through [TERPT]). We performed a systematic literature review of the long-term outcome of OPEN surgery compared with L-TERPT/TERPT.

Methods Our systematic review of the recent literature (2008 to 2012) included reports on long-term outcome of either OPEN surgery or L-TERPT/TERPT with a minimum follow-up period of 12 months. With the cumulative data, a comparative meta-analysis was performed for the outcome parameters “constipation,” “soiling/incontinence,” “enterocolitis,” and “anastomotic stricture.”

Results Functional outcome of surgical techniques for HD was highly variable. We could show a significant advantage of L-TERPT/TERPT over OPEN surgery regarding the incidence of soiling/incontinence and constipation. No differences were seen for enterocolitis and anastomotic stricture.

Conclusion Significant differences in the long-term outcome of OPEN surgery compared with L-TERPT/TERPT were identified in this review. We conclude from our data that L-TERPT/TERPT represents a valid option in the treatment of HD and might have some advantages over the OPEN techniques. However, the present data should be interpreted carefully due to limitations in the quality of the study design in most reports. Prospective, randomized, multicenter trials are urgently needed to overcome this weakness of the current literature.

Keywords

Hirschsprung - pull-through - outcome - open surgery - transanal surgery
 

  • References

  • 1 Swenson O, Bill Jr AH. Resection of rectum and rectosigmoid with preservation of the sphincter for benign spastic lesions producing megacolon; an experimental study. Surgery 1948; 24 (2) 212-220
    PubMedGoogle Scholar
  • 2 So HB, Schwartz DL, Becker JM, Daum F, Schneider KM. Endorectal “pull-through” without preliminary colostomy in neonates with Hirschsprung's disease. J Pediatr Surg 1980; 15 (4) 470-471
    CrossrefPubMedGoogle Scholar
  • 3 Georgeson KE, Fuenfer MM, Hardin WD. Primary laparoscopic pull-through for Hirschsprung's disease in infants and children. J Pediatr Surg 1995; 30 (7) 1017-1021 , discussion 1021–1022
    CrossrefPubMedGoogle Scholar
  • 4 De la Torre-Mondragón L, Ortega-Salgado JA. Transanal endorectal pull-through for Hirschsprung's disease. J Pediatr Surg 1998; 33 (8) 1283-1286
    CrossrefPubMedGoogle Scholar
  • 5 Albanese CT, Jennings RW, Smith B, Bratton B, Harrison MR. Perineal one-stage pull-through for Hirschsprung's disease. J Pediatr Surg 1999; 34 (3) 377-380
    CrossrefPubMedGoogle Scholar
  • 6 Gao Y, Li G, Zhang X , et al. Primary transanal rectosigmoidectomy for Hirschsprung's disease: Preliminary results in the initial 33 cases. J Pediatr Surg 2001; 36 (12) 1816-1819
    CrossrefPubMedGoogle Scholar
  • 7 Langer JC, Minkes RK, Mazziotti MV, Skinner MA, Winthrop AL. Transanal one-stage Soave procedure for infants with Hirschsprung's disease. J Pediatr Surg 1999; 34 (1) 148-151 , discussion 152
    CrossrefPubMedGoogle Scholar
  • 8 Liu DC, Rodriguez J, Hill CB, Loe Jr WA. Transanal mucosectomy in the treatment of Hirschsprung's disease. J Pediatr Surg 2000; 35 (2) 235-238
    CrossrefPubMedGoogle Scholar
  • 9 Huang Y, Zheng S, Xiao X. A follow-up study on postoperative function after a transanal Soave 1-stage endorectal pull-through procedure for Hirschsprung's disease. J Pediatr Surg 2008; 43 (9) 1691-1695
    CrossrefPubMedGoogle Scholar
  • 10 Ishikawa N, Kubota A, Kawahara H , et al. Transanal mucosectomy for endorectal pull-through in Hirschsprung's disease: comparison of abdominal, extraanal and transanal approaches. Pediatr Surg Int 2008; 24 (10) 1127-1129
    CrossrefPubMedGoogle Scholar
  • 11 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 (1) 41-47 , discussion 47
    CrossrefPubMedGoogle Scholar
  • 12 Elhalaby EA, Hashish A, Elbarbary MM , et al. Transanal one-stage endorectal pull-through for Hirschsprung's disease: a multicenter study. J Pediatr Surg 2004; 39 (3) 345-351 , discussion 345–351
    CrossrefPubMedGoogle Scholar
  • 13 Obermayr F, Szavay P, Beschorner R, Fuchs J. Outcome of transanal endorectal pull-through in patients with Hirschsprung's disease. Eur J Pediatr Surg 2009; 19 (4) 220-223
    Article in Thieme ConnectPubMedGoogle Scholar
  • 14 Tannuri AC, Tannuri U, Romão RL. Transanal endorectal pull-through in children with Hirschsprung's disease—technical refinements and comparison of results with the Duhamel procedure. J Pediatr Surg 2009; 44 (4) 767-772
    CrossrefPubMedGoogle Scholar
  • 15 Aslanabadi S, Ghalehgolab-Behbahan A, Zarrintan S, Jamshidi M, Seyyedhejazi M. Transanal one-stage endorectal pull-through for Hirschsprung's disease: a comparison with the staged procedures. Pediatr Surg Int 2008; 24 (8) 925-929
    CrossrefPubMedGoogle Scholar
  • 16 Aworanti OM, Mcdowell DT, Martin IM, Hung J, Quinn F. Comparative review of functional outcomes post surgery for Hirschsprung's disease utilizing the paediatric incontinence and constipation scoring system. Pediatr Surg Int 2012; 28 (11) 1071-1078
    CrossrefPubMedGoogle Scholar
  • 17 Dutta HK. Clinical experience with a new modified transanal endorectal pull-through for Hirschsprung's disease. Pediatr Surg Int 2010; 26 (7) 747-751
    CrossrefPubMedGoogle Scholar
  • 18 Gad El-Hak NA, El-Hemaly MM, Negm EH, El-Hanafy EA, Abdel Messeh MH, Abdel Bary HH. Functional outcome after Swenson's operation for Hirshsprung's disease. Saudi J Gastroenterol 2010; 16 (1) 30-34
    CrossrefPubMedGoogle Scholar
  • 19 Giuliani S, Betalli P, Narciso A , et al. Outcome comparison among laparoscopic Duhamel, laparotomic Duhamel, and transanal endorectal pull-through: a single-center, 18-year experience. J Laparoendosc Adv Surg Tech A 2011; 21 (9) 859-863
    CrossrefPubMedGoogle Scholar
  • 20 Gunnarsdóttir A, Larsson LT, Arnbjörnsson E. Transanal endorectal vs. Duhamel pull-through for Hirschsprung's disease. Eur J Pediatr Surg 2010; 20 (4) 242-246
    Article in Thieme ConnectPubMedGoogle Scholar
  • 21 Kim AC, Langer JC, Pastor AC , et al. Endorectal pull-through for Hirschsprung's disease-a multicenter, long-term comparison of results: transanal vs transabdominal approach. J Pediatr Surg 2010; 45 (6) 1213-1220
    CrossrefPubMedGoogle Scholar
  • 22 Mattioli G, Pini Prato A, Giunta C , et al. Outcome of primary endorectal pull-through for the treatment of classic Hirschsprung disease. J Laparoendosc Adv Surg Tech A 2008; 18 (6) 869-874
    CrossrefPubMedGoogle Scholar
  • 23 Nah SA, de Coppi P, Kiely EM , et al. Duhamel pull-through for Hirschsprung disease: a comparison of open and laparoscopic techniques. J Pediatr Surg 2012; 47 (2) 308-312
    CrossrefPubMedGoogle Scholar
  • 24 Nguyen TL, Bui DH, Tran AQ, Vu TH. Early and late outcomes of primary laparoscopic endorectal colon pull-through leaving a short rectal seromuscular sleeve for Hirschsprung disease. J Pediatr Surg 2009; 44 (11) 2153-2155
    CrossrefPubMedGoogle Scholar
  • 25 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 2011; 396 (7) 1027-1033
    CrossrefPubMedGoogle Scholar
  • 26 Sookpotarom P, Vejchapipat P. Primary transanal Swenson pull-through operation for Hirschsprung's disease. Pediatr Surg Int 2009; 25 (9) 767-773
    CrossrefPubMedGoogle Scholar
  • 27 Stensrud KJ, Emblem R, Bjørnland K. Functional outcome after operation for Hirschsprung disease—transanal vs transabdominal approach. J Pediatr Surg 2010; 45 (8) 1640-1644
    CrossrefPubMedGoogle Scholar
  • 28 Tang ST, Wang GB, Cao GQ , et al. 10 years of experience with laparoscopic-assisted endorectal Soave pull-through procedure for Hirschsprung's disease in China. J Laparoendosc Adv Surg Tech A 2012; 22 (3) 280-284
    CrossrefPubMedGoogle Scholar
  • 29 Yang L, Tang ST, Cao GQ , et al. Transanal endorectal pull-through for Hirschsprung's disease using long cuff dissection and short V-shaped partially resected cuff anastomosis: early and late outcomes. Pediatr Surg Int 2012; 28 (5) 515-521
    CrossrefPubMedGoogle Scholar
  • 30 Yokoi A, Satoh S, Takamizawa S, Muraji T, Tsugawa C, Nishijima E. The preliminary study of modified Swenson procedure in Hirschsprung disease. J Pediatr Surg 2009; 44 (8) 1560-1563
    CrossrefPubMedGoogle Scholar
  • 31 De la Torre L, Ortega A. Transanal versus open endorectal pull-through for Hirschsprung's disease. J Pediatr Surg 2000; 35 (11) 1630-1632
    CrossrefPubMedGoogle Scholar
  • 32 Hadidi A. Transanal endorectal pull-through for Hirschsprung's disease: a comparison with the open technique. Eur J Pediatr Surg 2003; 13 (3) 176-180
    Article in Thieme ConnectPubMedGoogle Scholar
  • 33 Langer JC. Laparoscopic and transanal pull-through for Hirschsprung disease. Semin Pediatr Surg 2012; 21 (4) 283-290
    CrossrefPubMedGoogle Scholar
  • 34 Langer JC, Durrant AC, de la Torre L , et al. One-stage transanal Soave pullthrough for Hirschsprung disease: a multicenter experience with 141 children. Ann Surg 2003; 238 (4) 569-583 , discussion 583–585
    PubMedGoogle Scholar
  • 35 Travassos DV, Bax NM, Van der Zee DC. Duhamel procedure: a comparative retrospective study between an open and a laparoscopic technique. Surg Endosc 2007; 21 (12) 2163-2165
    CrossrefPubMedGoogle Scholar
  • 36 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 (1) 271-277 , discussion 277
    CrossrefPubMedGoogle Scholar
  • 37 Levitt M, Peña A. Update on pediatric faecal incontinence. Eur J Pediatr Surg 2009; 19 (1) 1-9
    Article in Thieme ConnectPubMedGoogle Scholar
  • 38 Catto-Smith AG, Trajanovska M, Taylor RG. Long-term continence after surgery for Hirschsprung's disease. J Gastroenterol Hepatol 2007; 22 (12) 2273-2282
    CrossrefPubMedGoogle Scholar
  • 39 Georgeson KE. Hirschsprung's Disease. In: Holcomb III GW, Murphy JP, , eds. Ashcraft's Pediatric Surgery. 5th ed. Oxford: Elsevier LTD; 2010
    Google Scholar
  • 40 Rintala RJ, Pakarinen MP. Long-term outcomes of Hirschsprung's disease. Semin Pediatr Surg 2012; 21 (4) 336-343
    CrossrefPubMedGoogle Scholar
  • 41 Engum SA, Grosfeld JL. Long-term results of treatment of Hirschsprung's disease. Semin Pediatr Surg 2004; 13 (4) 273-285
    CrossrefPubMedGoogle Scholar
  • 42 Little DC, Snyder CL. Early and late complications following operative repair of Hirschsprung's disease. In: Holschneider AM, Puri P, , eds. Hirschsprung's Disease and Allied Disorders. 3rd ed. New York: Springer; 2003: 375-385
    Google Scholar
  • 43 Finlay IG, Renwick AA. Surgical Management of Constipation. In: Beynon J, Carr ND, , eds. Progress in Colorectal Surgery. London: Springer; 2005: 267
    CrossrefGoogle Scholar
  • 44 Yanchar NL, Soucy P. Long-term outcome after Hirschsprung's disease: patients' perspectives. J Pediatr Surg 1999; 34 (7) 1152-1160
    CrossrefPubMedGoogle Scholar
  • 45 Bax KN. Duhamel Lecture: the incurability of Hirschsprung's disease. Eur J Pediatr Surg 2006; 16 (6) 380-384
    Article in Thieme ConnectPubMedGoogle Scholar
  • 46 Di Lorenzo C, Solzi GF, Flores AF, Schwankovsky L, Hyman PE. Colonic motility after surgery for Hirschsprung's disease. Am J Gastroenterol 2000; 95 (7) 1759-1764
    PubMedGoogle Scholar
  • 47 Teitelbaum DH, Drongowski RA, Chamberlain JN, Coran AG. Long-term stooling patterns in infants undergoing primary endorectal pull-through for Hirschsprung's disease. J Pediatr Surg 1997; 32 (7) 1049-1052 , discussion 1052–1053
    CrossrefPubMedGoogle Scholar
  • 48 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 (11) 1766-1772
    CrossrefPubMedGoogle Scholar
  • 49 Heikkinen M, Rintala R, Luukkonen P. Long-term anal sphincter performance after surgery for Hirschsprung's disease. J Pediatr Surg 1997; 32 (10) 1443-1446
    CrossrefPubMedGoogle Scholar
  • 50 Jarvi K, Koivusalo A, Rintala RJ, Pakarinen MP. Anorectal manometry with reference to operative rectal biopsy for the diagnosis/exclusion of Hirschprung's disease in children under 1 year of age. Int J Colorectal Dis 2009; 24 (4) 451-454
    CrossrefPubMedGoogle Scholar
  • 51 Bai Y, Chen H, Hao J, Huang Y, Wang W. Long-term outcome and quality of life after the Swenson procedure for Hirschsprung's disease. J Pediatr Surg 2002; 37 (4) 639-642
    CrossrefPubMedGoogle Scholar
  • 52 Reding R, de Ville de Goyet J, Gosseye S , et al. Hirschsprung's disease: a 20-year experience. J Pediatr Surg 1997; 32 (8) 1221-1225
    CrossrefPubMedGoogle Scholar
  • 53 Shankar KR, Losty PD, Lamont GL , et al. Transanal endorectal coloanal surgery for Hirschsprung's disease: experience in two centers. J Pediatr Surg 2000; 35 (8) 1209-1213
    CrossrefPubMedGoogle Scholar
  • 54 Lacher M, Fitze G, Helmbrecht J , et al. Hirschsprung-associated enterocolitis develops independently of NOD2 variants. J Pediatr Surg 2010; 45 (9) 1826-1831
    CrossrefPubMedGoogle Scholar
  • 55 Coran AG, Teitelbaum DH. Recent advances in the management of Hirschsprung's disease. Am J Surg 2000; 180 (5) 382-387
    CrossrefPubMedGoogle Scholar
  • 56 Haricharan RN, Seo JM, Kelly DR , et al. Older age at diagnosis of Hirschsprung disease decreases risk of postoperative enterocolitis, but resection of additional ganglionated bowel does not. J Pediatr Surg 2008; 43 (6) 1115-1123
    CrossrefPubMedGoogle Scholar
  • 57 Teitelbaum DH, Cilley RE, Sherman NJ , 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 (3) 372-380
    CrossrefPubMedGoogle Scholar
  • 58 Hackam DJ, Filler RM, Pearl RH. Enterocolitis after the surgical treatment of Hirschsprung's disease: risk factors and financial impact. J Pediatr Surg 1998; 33 (6) 830-833
    CrossrefPubMedGoogle Scholar
  • 59 Nasr A, Langer JC. Evolution of the technique in the transanal pull-through for Hirschsprung's disease: effect on outcome. J Pediatr Surg 2007; 42 (1) 36-39 , discussion 39–40
    CrossrefPubMedGoogle Scholar
  • 60 Pastor AC, Osman F, Teitelbaum DH, Caty MG, Langer JC. Development of a standardized definition for Hirschsprung's-associated enterocolitis: a Delphi analysis. J Pediatr Surg 2009; 44 (1) 251-256
    CrossrefPubMedGoogle Scholar
  • 61 Teitelbaum DH, Coran AG. Long-term results and quality of life after treatment of Hirschsprung's disease and allied disorders. In: Holschneider AM, Puri P, , eds. Hirschsprung's Disease and Allied Disorders. 3rd ed. New York: Springer; 2008: 389-397
    CrossrefGoogle Scholar
  • 62 Swenson O. How the cause and cure of Hirschsprung's disease were discovered. J Pediatr Surg 1999; 34 (10) 1580-1581
    CrossrefPubMedGoogle Scholar