Transanal Endorectal Pull-Through With or Without Laparoscopic Assistance
Hirschsprung’s disease requires surgical treatment. Depending on the form of aganglionosis and severity of pathology, open or minimally invasive, transanal endorectal pull-through with or without laparoscopic assistance may be used.
The objective of the research was to study the efficiency of using transanal endorectal pull-through with and without laparoscopic assistance for treating Hirschsprung’s disease in children. We compared outcomes between approaches.
Materials and Methods. Over the period 2011-2016, 145 children with Hirschsprung’s disease were surgically treated using transanal endorectal pull-through (n=81) and laparoscopic-assisted transanal endorectal pull-through (n=64). A systematic literature review and meta-analysis were carried out.
Results. We noticed that transanal endorectal pull-through without laparoscopic assistance could be easily used in children under 4 years of age with aganglionosis including the sigmoid colon without significant colon dilatation considering a significant mesosigmoid mobility at such age. In other cases, we used laparoscopic-assisted transanal endorectal pull-through. The advantages of laparoscopic stage included the possibility for correct planning of surgical strategy, a thorough revision of the affected colon, determination of aganglionosis level, mobilization of the mesenterium, elimination of the adhesions and ligaments holding the colon, thereby avoiding tension in coloanal anastomosis, control and prevention of pull-through colon twisting which may cause an obstruction. In older patients, the proximal end of the rectum could be dissected laparoscopically. This allowed transanal endorectal pull-through to be performed quicker and safer. In the postoperative period, patients underwent rehabilitation with good functional results. Two children developed coloanal anastomotic dehiscence which was corrected by open stage treatment.
Conclusions. Age-related and anatomical features of the colon in the patients with Hirschsprung’s disease allowed performing transanal endorectal pull-through with or without laparoscopic assistance. Significant dilation of the colon, aganglionosis above the sigmoid area and the patient’s age over 4 years were indications for performing transanal endorectal pull-through with laparoscopic assistance. In other cases, transanal endorectal pull-through could be performed without laparoscopic assistance. The laparoscopic-assisted transanal endorectal pull-through procedure turned to be a safe and feasible technique for patients with Hirschsprung’s disease.
Abd El Baky Fahmy M, Abd El Hay S, Abd El H. Comparative study between transanal endorectal pull-through and modified Duhamel's procedure in management of Hirshsprung's disease. The Egyptian Journal of Hospital Medicine. 2019;74(3):679-683.
Arts E, Botden SM, Lacher M. Duhamel versus transanal endorectal pull through (TERPT) for the surgical treatment of Hirschsprung's disease. Techniques in Coloproctology. 2016;20(10):677-682. DOI: https://doi.org/10.1007/s10151-016-1524-5 [PMid:27628197 PMCid:PMC5040736]
Craigie RJ, Conway SJ, Cooper L et al. Primary pull-through for Hirschsprung's disease: comparison of open and laparoscopic-assisted procedures. J Laparoendosc Adv Surg Tech A. 2007;17(6):809-812. DOI: https://doi.org/10.1089/lap.2007.0081 [PMid:18158815]
El Halaby EA, Hasish A, El Barbary MM et al. Transanal one stage Endorectal pull-through for Hirschsprung's disease: A multi centric study. J Pediatr Surg. 2004;39(3):345-351. DOI: https://doi.org/10.1016/j.jpedsurg.2003.11.038 [PMid:15017550]
Fujiwaraa N, Kaneyama K. A comparative study of laparoscopy-assisted pull-through and open pull-through for Hirschsprung's disease with special reference to postoperative fecal continence. J Pediatr Surg. 2007;42(12):2071-2074. DOI: https://doi.org/10.1016/j.jpedsurg.2007.08.033 [PMid:18082710]
Gerogeson KE, Cohen RD, Hebra A et al. Primary laparoscopic endorectal colon pull-through for Hirschsprung's disease: a new gold standard. Ann Surg. 1999;229:678-682. DOI: https://doi.org/10.1097/00000658-199905000-00010 [PMid:10235526 PMCid:PMC1420812]
Gerogeson KE, Muensterer OJ. Laparoscopic-Assisted Transanal Pull-through for Hirschsprung's Disease. Holschnider AM, Prem Puri, editors. Hirschsprung's disease and Allied disorders. Springer. 2008;3:323-333. DOI: https://doi.org/10.1007/978-3-540-33935-9_31
Gosain A, Frykman PK, Cowles RA et al. Guidelines for the diagnosis and management of Hirschsprung-associated enterocolitis. Pediatr Surg Int. 2017;33(5):517-521. DOI: https://doi.org/10.1007/s00383-017-4065-8 [PMid:28154902 PMCid:PMC5395325]
Guerra J, Wayne C, Musambe T et al. Laparoscopic-assisted transanal pull-through (LATP) versus complete transanal pull-through (CTP) in the surgical management of Hirschsprung's disease. J Pediatr Surg. 2016;51(5):770-774. DOI: https://doi.org/10.1016/j.jpedsurg.2016.02.020 [PMid:26949144]
Gunnarsdottir A, Larsson LT, Arnbjornsson E. Transanal endorectal vs. Duhamel pull-through for Hirschsprung's disease. Eur J Pediatr Surg. 2010;20(4):242-246. DOI: https://doi.org/10.1055/s-0030-1252006 [PMid:20393896]
Jiao CL, Chen XY, Feng JX. Novel insights into the pathogenesis of Hirschsprung's-associated Enterocolitis. Chin Med J (Engl). 2016;129(12):1491-1497. DOI: https://doi.org/10.4103/0366-6999.183433 [PMid:27270548 PMCid:PMC4910376]
Kryvchenia DYu, Prytula VP, Silchenko MI et al Rezultaty likuvannia ditei z khvoroboiu Hirshprunha. Prohnozy ta shliakhy pokrashchennia. Khirurhiia dytiachoho viku. 2008;(4):51-54.
Neuvonen MI, Kyrklund K, Rintala RJ et al. Bowel Function and Quality of Life After Transanal Endorectal Pull-through for Hirschsprung Disease. Ann Surg. 2017;265(3):622-629. DOI: https://doi.org/10.1097/SLA.0000000000001695 [PMid:28169931]
Li X, Cheng J, Zhang Y et al. Laparoscopic-assisted endorectal pull-through for Hirschsprung's disease. Saudi Med J. 2017;38(12):1255-1258. DOI: https://doi.org/10.15537/smj.2017.12.20859 [PMid:29209677 PMCid:PMC5787639]
Mao Y-Z, Tang S-T, Li S. Duhamel operation vs. transanal endorectal pull-through procedure for Hirschsprung disease: A systematic review and meta-analysis. J Pediatr Surg. 2018;53(9):1710-1715. DOI: https://doi.org/10.1016/j.jpedsurg.2017.10.047 [PMid:29137805]
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. DOI: https://doi.org/10.1016/j.jpedsurg.2006.09.028 [PMid:17208538]
Prytula VP, Silchenko MI, Hussaini SF et al. Transanal endorectal pull-through and resection of colon, as modern approach to the treatment of Hirschprung's disease in chidren. Archive of Clinical Medicine. 2010;2:93-94.
Supchatura M, Buranakitjaroen V, Nithipanya N et al. Results of the Treatment of Hirschsprung's Disease: Comparison between Transabdominal and Transanal Endorectal Pull-through Operations. The Thai Journal of Surgery. 2016;37(1):6-1.
Tannuri AC, Tannuri U, Romao RL. Transanal endorectal pullthrough in children with Hirschsprung's disease - technical refinements and comparison of results with the Duhamel procedure J Pediatr Surg. 2009;44(4):767-72. DOI: https://doi.org/10.1016/j.jpedsurg.2008.08.002 [PMid:19361638]
Till H, Heinrich M, Schuster T et al. Is the anorectal sphincter damaged during a transanal endorectal pull-through (TERPT) for Hirschsprung's disease? A 3-dimensional, vector manometric investigation. Eur J Pediatr Surg. 2006;16(3):188-191. DOI: https://doi.org/10.1055/s-2006-924220 [PMid:16909358]
Wang NL, Lee HC, Yeh ML et al. Experience with primary laparoscopy-assisted endorectal pull-through for Hirschsprung's disease. Pediatr Surg Int. 2004;20:118-122. DOI: https://doi.org/10.1007/s00383-003-1102-6 [PMid:14745575]
Copyright (c) 2019 Oleh Kurtash
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.Authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access).