Multicenter Experience of Primary Transanal Endorectal Pull-Through Operation in Childhood Hirschsprung’s Disease
Tawan Imvised MD*, Paisarn Vejchapipat MD**, Piyawan Chiengkriwate MD***, Piangpen Thepsuwan MD****, Kulsiri Tiansri MD*****, Siriphut Kiatipunsodsai MD*
Affiliation : * Thammasat University Hospital, Pathumthani, Thailand ** King Chulalongkorn Memorial Hospital, Bangkok, Thailand *** Songklanagarind Hospital, Songkhla, Thailand **** Vajira Hospital, Bangkok, Thailand ***** Maharat Nakhon Ratchasima Hospital, Nakhon Ratchasima, Thailand
Background : Hirschsprung’s disease (HD) is the most common intestinal obstruction in newborn. The Transanal Endorectal
Pull -Through (TERPT) is a new surgical procedure that has rapidly replaced traditional ones.
Objective : We have reviewed early post-operative complications after TERPT of childhood HD in Thailand.
Material and Method: The clinical course and a 1 year outcome of all pediatric HD undergoing TERPT from 5 pediatric
surgical centers in Thailand between 2008 and 2011 were reviewed.
Results : Seventy-six patients (66 males and 10 females) of HD were included. The average age of diagnosis and surgery are
199 (0-4,015) and 297 (9-4,075) days, respectively, where ages and classification of HD are not related. The associated
conditions are Down syndrome (DS) 6.6% and congenital heart disease (CHD) 5.3%. The most common presented symptom
was intestinal obstruction. Other symptoms were Hirschsprung, which are associated with enterocolitis (HAEC) 13.1% and
intestinal perforation 2.6%. The patients were diagnosed by barium enema (BE) 93.4%, rectal biopsy (RB) 6.6% and
anorectal manometry (ARM) 6.6%. HAEC is the most common both pre- and post-operative complications (23.7% and
22.4%). Other post-operative complications are incontinence 13.2%, perianal excoriation 9.2%, anastomosis stricture
7.9%, anastomosis leakage 2.6%, retained aganglionic segment 2.6%, anastomosis volvulus 1.3% and anovaginal fistula
1.3%. One patient died due to anastomosis leakage (1.3%). Five patients were associated with DS, 3 patients (60%) were
incontinent, 1 patient had anastomosis stricture (20%) and 2 patients (40%) was HAEC.
Conclusion : Most of HD were diagnosed and treated in the newborn period. TERPT is safe and also feasible in all pediatric
age groups. The associated DS are related to have more morbidity. HAEC is the most common complication. Even though
there are limitations in the diagnostic investigation those did not achieve the standard diagnosis of HD in this study; but the
outcomes are not different from the reviews. The improvement in laboratories and pathological investigation services will
reflect the surgical service and outcome of pediatric HD in this region. The awareness of post-operative complications will
lead to the prevention and early management in the postoperative period.
Keywords : Hirschsprung’s disease, Transanal Endorectal Pull- Through, Post-operative complication
