Treatment of classic-type Hirschsprung’s disease: rectoplasty with posterior triangular colonic flap versus transanal endorectal pull-through with rectoanal myotomy
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Our institution employs rectoplasty with a posterior triangular colonic flap (RPTCF) for classic-type Hirschsprung’s disease. Recently, we employed a modified Soave procedure: transanal endorectal pull-through with rectoanal myotomy (TEPTRAM). In both procedures, the internal sphincter muscle is completely divided vertically at the 6 o’clock position. Unlike RPTCF, TEPTRAM does not require abdominal manipulation. We aimed to verify the usefulness of TEPTRAM.
64 patients with classic-type Hirschsprung’s disease who underwent surgery between 1970 and 2017 were divided into group R (RPTCF, 47 cases) and group T (TEPTRAM, 17 cases). We compared the defecation function of the groups.
No patient showed fecal incontinence (R: 0/41, T: 0/10, ns). Three patients (6%) in group R and four (24%) in group T developed postoperative enterocolitis (P = 0.16). Three patients (10%) in group R and one (20%) in group T needed an enema (P = 0.36).
There was no adverse effect of rectoanal myotomy; incontinence was not observed in either procedure. Although there was no significant difference, the incidences of enterocolitis and constipation were slightly higher in group T, perhaps because of the residual muscle cuff; therefore, it is necessary to provide best care with attention to constipation immediately after surgery.
KeywordsHirschsprung’s disease Rectoanal myotomy Transanal endorectal pull-through Posterior triangular colonic flap Soave procedure Duhamel procedure
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
This study was approved by the ethics committee of Tohoku University Graduate School of Medicine and has, therefore, been performed in accordance with the ethical standards laid down in the Declaration of Helsinki, 1964, and its later amendments.
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