Endorectal pull-through for Hirschsprung's disease-a multicenter, long-term comparison of results

transanal vs transabdominal approach

Anne C. Kim, Jacob C. Langer, Aimee C. Pastor, Lingling Zhang, Cornelius E J Sloots, Nicholas Hamilton, Matthew D. Neal, Brian T. Craig, Erin K. Tkach, David J. Hackam, Nicolaas M A Bax, Patrick A. Dillon, Jennifer N. Chamberlain, Daniel H. Teitelbaum

Research output: Contribution to journalArticle

49 Citations (Scopus)

Abstract

Purpose: Previous studies have reported decreased continence in patients undergoing transanal endorectal pull-through (TERP) for Hirschsprung's disease compared to the older transabdominal approach (TAA). To address this, we examined long-term stooling outcomes in a large, multicenter cohort of patients undergoing either TERP or TAA. Methods: Data were collected from 5 large pediatric institutions. Patient families were surveyed using a stooling score system (0-40, best to worst total score). Inclusion criteria included patients older than 3 years and those who had more than 6 months of recovery after pull-through. Those with total colonic aganglionosis were excluded. Statistical analysis included univariate and multivariate linear regression (significance, P <.05). Results: Two hundred eighty-one patients underwent TERP (192) or TAA (89). Interviews were completed in 149 (104 [52%] TERP vs 45 [52%] TAA). The TAA group had a significantly greater number of daily bowel movements for each respective postoperative year and experienced more early complications (3% vs 1% with >1 complication; P = .061) and late complications (19% vs 4% with >1 complication; P <.001). Although the TAA group had a higher mean enterocolitis score (3.3 ± 0.4 vs 1.8 ± 0.2; P <.001), this was not borne out by multivariate regression analysis (P = .276). Parental survey showed that there were no significant differences between procedures in mean total, continence, or stooling pattern scores. Conclusion: Transanal endorectal pull-through was associated with fewer complications and fewer episodes of enterocolitis. In contrast to prior studies, TERP patients did not have a higher rate of incontinence. These results support use of TERP as an excellent surgical approach for children with Hirschsprung's disease.

Original languageEnglish (US)
Pages (from-to)1213-1220
Number of pages8
JournalJournal of Pediatric Surgery
Volume45
Issue number6
DOIs
StatePublished - 2010
Externally publishedYes

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Hirschsprung Disease
Enterocolitis
Linear Models
Multivariate Analysis
Regression Analysis
Pediatrics

Keywords

  • Continence
  • Enterocolitis
  • Hirschsprung's disease
  • Pull-through
  • Stooling

ASJC Scopus subject areas

  • Surgery
  • Pediatrics, Perinatology, and Child Health
  • Medicine(all)

Cite this

Endorectal pull-through for Hirschsprung's disease-a multicenter, long-term comparison of results : transanal vs transabdominal approach. / Kim, Anne C.; Langer, Jacob C.; Pastor, Aimee C.; Zhang, Lingling; Sloots, Cornelius E J; Hamilton, Nicholas; Neal, Matthew D.; Craig, Brian T.; Tkach, Erin K.; Hackam, David J.; Bax, Nicolaas M A; Dillon, Patrick A.; Chamberlain, Jennifer N.; Teitelbaum, Daniel H.

In: Journal of Pediatric Surgery, Vol. 45, No. 6, 2010, p. 1213-1220.

Research output: Contribution to journalArticle

Kim, AC, Langer, JC, Pastor, AC, Zhang, L, Sloots, CEJ, Hamilton, N, Neal, MD, Craig, BT, Tkach, EK, Hackam, DJ, Bax, NMA, Dillon, PA, Chamberlain, JN & Teitelbaum, DH 2010, 'Endorectal pull-through for Hirschsprung's disease-a multicenter, long-term comparison of results: transanal vs transabdominal approach', Journal of Pediatric Surgery, vol. 45, no. 6, pp. 1213-1220. https://doi.org/10.1016/j.jpedsurg.2010.02.087
Kim, Anne C. ; Langer, Jacob C. ; Pastor, Aimee C. ; Zhang, Lingling ; Sloots, Cornelius E J ; Hamilton, Nicholas ; Neal, Matthew D. ; Craig, Brian T. ; Tkach, Erin K. ; Hackam, David J. ; Bax, Nicolaas M A ; Dillon, Patrick A. ; Chamberlain, Jennifer N. ; Teitelbaum, Daniel H. / Endorectal pull-through for Hirschsprung's disease-a multicenter, long-term comparison of results : transanal vs transabdominal approach. In: Journal of Pediatric Surgery. 2010 ; Vol. 45, No. 6. pp. 1213-1220.
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abstract = "Purpose: Previous studies have reported decreased continence in patients undergoing transanal endorectal pull-through (TERP) for Hirschsprung's disease compared to the older transabdominal approach (TAA). To address this, we examined long-term stooling outcomes in a large, multicenter cohort of patients undergoing either TERP or TAA. Methods: Data were collected from 5 large pediatric institutions. Patient families were surveyed using a stooling score system (0-40, best to worst total score). Inclusion criteria included patients older than 3 years and those who had more than 6 months of recovery after pull-through. Those with total colonic aganglionosis were excluded. Statistical analysis included univariate and multivariate linear regression (significance, P <.05). Results: Two hundred eighty-one patients underwent TERP (192) or TAA (89). Interviews were completed in 149 (104 [52{\%}] TERP vs 45 [52{\%}] TAA). The TAA group had a significantly greater number of daily bowel movements for each respective postoperative year and experienced more early complications (3{\%} vs 1{\%} with >1 complication; P = .061) and late complications (19{\%} vs 4{\%} with >1 complication; P <.001). Although the TAA group had a higher mean enterocolitis score (3.3 ± 0.4 vs 1.8 ± 0.2; P <.001), this was not borne out by multivariate regression analysis (P = .276). Parental survey showed that there were no significant differences between procedures in mean total, continence, or stooling pattern scores. Conclusion: Transanal endorectal pull-through was associated with fewer complications and fewer episodes of enterocolitis. In contrast to prior studies, TERP patients did not have a higher rate of incontinence. These results support use of TERP as an excellent surgical approach for children with Hirschsprung's disease.",
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T2 - transanal vs transabdominal approach

AU - Kim, Anne C.

AU - Langer, Jacob C.

AU - Pastor, Aimee C.

AU - Zhang, Lingling

AU - Sloots, Cornelius E J

AU - Hamilton, Nicholas

AU - Neal, Matthew D.

AU - Craig, Brian T.

AU - Tkach, Erin K.

AU - Hackam, David J.

AU - Bax, Nicolaas M A

AU - Dillon, Patrick A.

AU - Chamberlain, Jennifer N.

AU - Teitelbaum, Daniel H.

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