Transanal endorectal coloanal surgery for Hirschsprung's disease: Experience in two centers

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.