Transanal mucosectomy in the treatment of Hirschsprung's disease

Background/Purpose:Transanal mucosectomy of the aganglionic segment of colo n is a critical step in minimally invasive surgery for Hirschsprung's disea se. The purpose of this study was to examine the outcome of patients underg oing transanal mucosectomy. Methods: From January 1979 to November 1998, 26 patients (ages 25 days to 1 7 years) underwent transanal mucosectomy for Hirschsprung's disease. Sevent een (65%) had partial transanal mucosectomy (PTM; 1979 to 1998) and 9 (35%) complete transanal mucosectomy (CTM; 1995 to 1998). In PTM, a 2- to 3-cm m ucosal dissection was begun 1 cm above the dentate line in conjunction with transabdominal endorectal dissection (modified Soave). In CTM, the entire mucosal dissection was performed transanally as part of a laparoscopically assisted Soave procedure. Results were obtained by chart review and persona l communication. Patients were assessed clinically for continence where age appropriate (>3 years) and for development of constipation, postoperative enterocolitis, and anal stricture. Results: One of 16 (6.2%) of the PTM group was incontinent versus none (4 p atients) in the CTM group. Five of 17 (29.4%) of the PTM group were constip ated Versus 4 of 9 (44.4%) in the CTM group (t test, P = not significant). Postoperative enterocolitis developed in 4 of 17 (23.5%) of the PTM group v ersus 6 of 9 (66.6%) in the CTM group (t test, P <.05). Three of 6 (50%) of the CTM group versus none in the PTM group required hospitalization for bo wel rest, rectal washouts, and antibiotics. All patients were well at the t ime of the report. Anal stricture was not seen in either group. Conclusions: Constipation and postoperative enterocolitis are a significant feature of transanal mucosectomy for Hirschsprung's disease deserving clos e surveillance, especially in patients in whom the entire mucosal dissectio n was performed transanally. Continence appears to be satisfactorily preser ved from these preliminary results. J Pediatr Surg 35:235-238. Copyright (C ) 2000 by W.B. Saunders Company.