Comparison of the Results of Transanal Endorectal Pull-through and Martin-modified Duhamel Operations in Hirschsprung Disease

Abstract

Objectives: We compared the results of patients who underwent transanal endorectal pull-through (TEPT) and Martin-modified Duhamel operations for Hirschsprung’s disease (HD). Materials and Methods: Between 2002 and 2007, we evaluated 53 patients with HD treated with TEPT (group 1, n=24), endorectal pull-through with a laparotomy requirement after an initiated transanal approach (group 2, n=12) and Martin-modified Duhamel (group 3, n=17). Age, gender,length of aganglionic segment, intraoperative details, postoperative early complications and long term functional outcomes are evaluated and compared among these patient groups. Results: In this study age at the time of the operation, duration of the operation, time to first oral feeding, time to first stool and hospital stay in the patients the group 1 were significantly less or shorter than those ones in group 2 and group 3 (p<0.001). Blood transfusion requirement during operation in group 1 was less than the other groups, but this difference didn’t reach statistical significance (p>0.05). Postoperative enterocolitis had a higher incidence in group 3, but there was also no significant difference (p>0.05). There was no difference in the long-term functional results(continence, fecal soiling, constipation) of all three procedures (p>0.05). Conclusion: TEPT is both a feasible and safe technique. It may be the first choice particularly in patients with early diagnosed rectosigmoid HD patients without enterocolitis or bowel dilatation.

Keywords

• Words: Transanal Endorectal Pull-through
• Hirshsprung’s Disease
• Duhamel Pull-through

Hirschsprung Hastalığında Transanal Endorektal Pull-through ve Martin-modifiye Duhamel Ameliyatlarının Sonuçlarının Karşılaştırılması

Abstract

Amaç: Hirschsprung hastalığı (HH) tanısıyla transanal endorektal pull-through (TEPT) ve Martin-modifiye Duhamel ameliyatları yapılmış olan hastalarımızın sonuçlarının karşılaştırması. Gereç ve Yöntem: Kliniğimizde 2002-2007 yılları arasında HH nedeniyle TEPT (grup 1, n=24), transanal yolla başlanıp laparotomi gerektiren endorektal pull-through (grup 2, n=12) ve Martin modifiye Duhamel (grup 3, n=17) uygulanan 53 hasta değerlendirildi. Bu hasta grupları yaş, cinsiyet, aganglionik segment uzunluğu, intraoperatif detaylar, postoperatif erken dönem komplikasyonlar ve uzun dönem fonksiyonel sonuçlar açısından değerlendirildi ve karşılaştırıldı. Bulgular: Çalışmamızda grup 1 hastaların ortalama ameliyat yaşı, ameliyat süresi, oral beslenmeye başlama zamanı, ilk gaita çıkarma zamanı ve hastanede kalış süresi grup 2 ve grup 3 hastalarla karşılaştırıldığında anlamlı olarak az veya kısa bulundu (p<0,001). Ameliyat sırasında kantransfüzyonu ihtiyacı yüzde olarak grup 1 hastalarda daha az olmasına rağmen aradaki bu fark istatistiksel olarak anlamlı bulunmadı (p>0,05). Serimizde postoperatif enterokolit oranı grup 3’te yüzde olarak daha yüksek bulunmasına rağmen aralarındaki bu fark anlamlı bulunmadı (p>0,05). Her üç düzeltici tekniğin uzun dönem fonksiyonel sonuçları (kontinans, fekal soiling, kabızlık) değerlendirilip karşılaştırıldığında aralarında anlamlı bir fark bulunmadı (p>0,05). Sonuç: TEPT tekniği kolay uygulanabilen güvenli bir tekniktir. Özellikle erken dönemde tanı konmuş, enterokolit öyküsü olmayan, henüz bağırsak dilatasyonu gelişmemiş, rektosigmoid tutulumlu HH’lerde TEPT ilk tercih olabilir.

Keywords

• Transanal Endorektal Pull-through
• Hirschsprung Hastalığı
• Duhamel Pull-through

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