Early Surgical Complications Following Transanal Endorectal Pull-through for Hirschsprung’s Disease

Abstract

Objective: The purpose of this study was to examine factors affecting early complications following transanal endorectal pull-through (TERPT) in patients with Hirschprung’s disease. Materials and Methods: Retrospective chart reviews of patients with Hirschsprung’s disease who underwent TERPT/ abdominal assisted TERPT at Siriraj Hospital between January 2009 and December 2019 was carried out. . Results: The overall complication rate was 26% (43/163). The complications were as follows: 14 cases of anastomotic strictures (32.6%), five cases of abscess at anastomosis (11.6%), and three cases of anastomotic leakages (7.0%). In regards to preoperative bowel preparation, when comparing those with and those without post-operative complications, the amount of NSS for rectal irrigation (ml/Kg), duration required (days), and duration of changed diet (days) were the same. Colostomy prior to a pull-through operation could not prevent post-operative complications following endorectal pull-through (p = 1.000). The incidences of early complications following TERPT and abdominal assisted TERPT was the same (p = 0.344). Abdominal assisted TERPT had a higher incidence (4%) of anastomotic leakages whereas TERPT had a higher rate of anastomosis strictures (12%) compared to o abdominal assisted TERPT (5%). The higher the transitional zone, the higher the complication rate. Anastomotic leakages, the most serious complication, rarely occurred following TERPT in the low transitional zone. Conclusion: There was no significant risk factor associated with early surgical complications following TERPT. Abdominal assisted TERPT should be selected properly according to the level of transitional zone. The complications correlate with whether a perfect pull-through operation could be performed or not.

Keywords

• Hirschsprung
• endorectal pullthrough
• complications
• anastomosis
• bowel preparation