Transanal endo rectal pull-through versus trans abdominal pull-through in management of hirschsprungs disease

Introduction: Hirschsprung's Disease (HD) is a common congenital disease of
colorectum. The initially treatment consisted of preoperative diverting colostomy, followed
by definite abdominal pull-through and closure of colostomy on later date. This study was
conducted to compare Trans Endo Rectal Pull Through (TERPT) and Trans Abdominal Pull
Through (TAP) methods in patients with HD.
Methods: 62 children (39 males and 23 females) with proven HD on the basis of rectal
biopsy or barium enema underwent TAP or TERPT in one center and by unique operative
team between January 2009 and August 2011. Children with a prineal disease, concomitant
congenital anomaly, and total colonic agangelionosis were excluded. All patients had post
operative pathologic proof.
Results: 12 months follow-up showed that, the most common post operative complication
in both groups was perianal excoriation (24.2%) followed by enterocolitis (22.53%), soilage
(20.96%), constipation (14.50%), anal stricture (6.5%), fecal incontinency (3.2%) and
anastomosis leak (3.2%). There was a significant difference between TERPT and TAP
groups in operative time (107-155 min), surgical site infection (all 5 patients were in tap
group), need to re-hospitalization (25%-41.5%) and cosmetic (4%-62.2%). There was no
difference between age and sex of the patients and post operative complication.
Conclusion: TERPT in comparison to TAP would be an alternative, safe technique for HD
patients. The TERPT approach is less invasive and can provide a better clinical outcome
than TAP in terms of operative time, surgical site infection need to re-hospitalization and
cosmetic.