A follow-up study on postoperative function after a transanal Soave 1-stage endorectal pull-through procedure for Hirschsprung's disease

Abstract

Objective: The aim of the study is to appraise bowel movements in children with Hirschsprung's disease (HD) after a transanal Soave 1-stage endorectal pull-through (TAS) procedure.

Methods: From October 2000 to October 2004, 44 patients with HD underwent a TAS procedure, 35 had a Soave operation via a laparotomy, 29 underwent a Soave procedure via laparoscopy, and 39 had an Ikeda-Soper procedure; the patients were followed up from 1 to 5 years after surgery. Evaluation of the perioperative therapeutic effect and postoperative bowel movements between the 4 groups were analyzed by Kelly's score and anorectal manometry.

Results: The TAS procedure required less operative time and costs than the Soave procedure via laparotomy or laparoscopy (P < .05) and less than that of Ikeda-Soper procedure for the duration of the preoperative preparation, the duration of the surgical procedure, intraoperative blood transfusions, days of postoperative fasting, antibiotic use, and days and cost of hospitalization (P < .01). There were no differences in short-term and long-term complications between the same Soave procedures; the Soave procedure exceeded the Ikeda-Soper operation in the incidence of enterocolitis 3 months postoperatively (P < .05), but there was no difference between the TAS procedure and the Ikeda-Soper procedure. There was no difference in bowel movements 12 months postoperatively and the rectal anal inhibitory reflex, high-pressure zone length, resting anal canal pressure, and the sensation threshold 1 year postoperatively between the TAS procedure and the Ikeda-Soper procedure, but the active contractile pressure was lower after the TAS procedure than the Ikeda-Soper procedure.

Conclusions: The TAS procedure is more suitable than the Soave operation via laparotomy or laparoscopy and Ikeda-Soper procedure and is feasible in infants with short segment type and common type HD.