Kr. Shankar et al., Transanal endorectal coloanal surgery for Hirschsprung's disease: Experience in two centers, J PED SURG, 35(8), 2000, pp. 1209-1213
Background/Purpose: Transanal mucosal proctectomy with low coloanal anastom
osis has been used widely in the treatment of rectal malignancies, ulcerati
ve colitis, and familial polyposis. The use of this technique for Hirschspr
ung's disease is a relatively new concept. The aim of this study was to eva
luate and compare the results of transanal endorectal coloanal anastomosis
(TECA) for Hirschsprung's disease from 2 centers.
Methods: All children who underwent TECA for Hirschsprung's disease at Alde
r Hey Children's Hospital, Liverpool, England from January 1995 to December
1998 (n = 41) and the Children's Hospital, Helsinki, Finland from June 198
8 to December 1998 (n = 95) were evaluated. Patient demographics, age at di
agnosis, initial management, length of aganglionic segment, and age at oper
ation were documented. Postoperative complications and functional outcome w
ere analyzed.
Results: Patient demographics were similar in the 2 centers. Age at diagnos
is was less than 1 month in 71% of children at Liverpool, compared with 53%
at Helsinki. Sixteen (39%) patients in Liverpool and 75 (79%) patients in
Helsinki underwent primary TECA without colostomy. Postoperative enterocoli
tis occurred in 14 of 136 patients (10%). An ischemic stricture of the colo
n was documented in 4 children in the Liverpool series, 2 of whom had TECA
as a salvage procedure after a previously failed Duhamel pull-through opera
tion. Frequency of bowel movements, seen in the immediate postoperative per
iod in most patients gradually improved with time from a median of 5 (range
, 2 to 12) bowel movements a day at 3 months after TECA to 2 (range, 1 to 6
) bower movements a day at 2 years' follow-up. Assessment of continence was
possible in 51 of 136 patients (37%) over the age of 4 years. Thirty-nine
children had normal bowel function giving an overall success rate of 76%.
Conclusions: Transanal endorectal coloanal anastomosis is a good technique
for treatment of Hirschsprung's disease with few operation-related complica
tions. Based on the data emerging from these 2 centers the functional outco
me is highly satisfactory and comparable with other established procedures.
J Pediatr Surg 35:1209-7213. Copyright (C) 2000 by W.B. Saunders Company.