32nd Annual Congress of Turkish Pediatric Surgical Association

Introduction: In recent years, transanal endorectal pull-through (TERPT) which was first introduced in the late 1990s has been more commonly performed in the surgical treatment of Hirschsprung’s disease (HD). The aim of this study is to present our experience with this operative approach with special emphasis on our early postoperative results.

Material and Method: A retrospective study from August 2013 to April 2014 was carried out in 13 children (12 males and 1 female) with biopsy proven HD who underwent TERPT. The feasibility of a TEPT was assessed by a preoperative barium enema. If the radiological transition zone was evident at the rectosigmoid or descending colon, TERPT was performed.

Results: The mean age of the patients was 27.2±34.6 months (2 months- 9 years). The mean follow-up was 6.7±2.6 months (2-10 months). Four of the patients had a previous colostomy.  The mean operative time was 132 minutes (90-180 minutes). There was only one conversion to open surgical pull-through technique. None of the patients had anastomotic leak or any signs of cuff abscess. Mean time before resuming oral intake was 3.5±3.3 days (1-10 days). Mean postoperative hospitalization period was 8.1±3.8 days (4-15 days). Postoperative enterocolitis occurred in 4 (30.8%) children, of which 2 were in the early postoperative period. All of them were treated with oral antibiotics, saline enema and an extended anal dilatation. Transient perianal dermatitis occurred in 10 patients (76.9%), which resolved after an average period of 1 month. Anostomotic stricture was seen in 1 (7.7%), which was managed by anal dilatation. All 3 patients over the age of 3 years have voluntary bowel movement and no soiling.

Conclusion: These results suggest that TERPT is a safe and feasible approach with technical advantages, sufficient functional outcomes and decreased incidence of complications.

Giriş: Transanal endorektal pull-through (TERPT) ameliyatı Hirschsprung hastalığı (HH)’nın cerrahi tedavisinde son yıllarda giderek daha yaygın olarak kullanılmaktadır. Bu çalışmanın amacı, TERPT tekniği  ile ilgili deneyimlerimizi  ve erken dönem sonuçlarımızı irdelemektir. 

Hastalar ve Yöntem: Ağustos 2013- Nisan 2014 tarihleri arasında HH nedeni ile TERPT yapılan 13 (12 erkek, 1 kız) hasta geriye dönük olarak incelendi. Preoperatif kolon grafisinde radyolojik transizyonel zonu rektosigmoid veya inen kolonda tespit edilen olgulara TERPT uygulandı.

Bulgular: Hastaların ortalama yaşı 27.2±34.6 ay (2 ay-9 yaş), ortalama izlem süresi 6.7±2.6 ay (2-10 ay) idi. Dört hastanın kolostomisi mevcuttu. Hastaların ortalama operasyon süresi 132 dk (90-180 dk) idi. Bir hastada açık cerrahiye geçildi. Hiçbir hastada anastamoz kaçağı veya cuff apsesi gelişmedi. Ortalama oral başlama süresi 3.5±3.3 gün (1-10 gün), ortalama hastanede kalış süresi 8.1±3.8 gün (4-15 gün) idi. 4 (%30.8) hastada postoperatif enterokolit gelişti, bunlardan 2’si erken dönemde idi. Hastaların tamamı oral antibiyotik, izotonik lavman ve zorlu anal dilatasyon ile tedavi edildi. 10 (%76.9) hastada görülen geçici perianal dermatit yaklaşık 1 ayda düzeldi. Bir (%7.7) hastada gelişen anastamoz darlığı anal dilatasyon ile tedavi edildi. Üç yaşından büyük olan 3 hastamızın hepsinde istemli barsak hareketi mevcut olup hiçbirinde soiling gelişmedi.

Sonuç: TERPT teknik kolaylığı, yeterli fonksiyonel sonuçları ve düşük komplikasyon oranı ile güvenli ve uygulanabilir bir yöntemdir.