Satoshi Obata1, Satoshi Ieiri2, Takashi Akiyama3, Naoto Urushihara4, Hisayoshi Kawahara5, Masayuki Kubota6, Miyuki Kono7, Yuji Nirasawa8, Shohei Honda9, Masaki Nio10, Tomoaki Taguchi11. 1. The Japanese Study Group for Hirshsprung's disease; Department of Pediatric Surgery, Reproductive and Developmental Medicine, Faculty of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan. 2. The Japanese Study Group for Hirshsprung's disease; Department of Pediatric Surgery, Field of Developmental Medicine, Kagoshima University, Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima, 890-8520, Japan. 3. The Japanese Study Group for Hirshsprung's disease; Department of Pediatric Surgery, Hiroshima City Hiroshima Citizen Hospital, 7-33, Moto-machi, Naka-ku, Hiroshima, 730-8518, Japan. 4. The Japanese Study Group for Hirshsprung's disease; Department of Pediatric Surgery, Shizuoka Children's Hospital, 860, Urushiyama, Aoi-ku, Shizuoka, 420-0953, Japan. 5. The Japanese Study Group for Hirshsprung's disease; Department of Pediatric Surgery, Hamamatsu University Hospital, 1-20-1, Handayama, Higashi-ku, Hamamatsu, Shizuoka, 431-3192, Japan. 6. The Japanese Study Group for Hirshsprung's disease; Department of Pediatric Surgery, Niigata University Graduate School of Medicine and Dental Sciences, 1-757, Asahimachi-Dori, Chuo-ku, Niigata, 951-8510, Japan. 7. The Japanese Study Group for Hirshsprung's disease; Department of Pediatric Surgery, Kanazawa Medical University, 1-1, Daigaku, Uchinada-machi, Kahoku-gun, Ishikawa, 920-0293, Japan. 8. The Japanese Study Group for Hirshsprung's disease; Department of Pediatric Surgery, Kyorin University School of Medicine, 6-20-2, Shinkawa, Mitaka, Tokyo, 181-0004, Japan. 9. The Japanese Study Group for Hirshsprung's disease; Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, 5, Kita-14jo-nishi, Kita-ku, Sapporo, Hokkaido, 060-8648, Japan. 10. The Japanese Study Group for Hirshsprung's disease; Department of Pediatric Surgery, Tohoku University School of Medicine, 1-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-0872, Japan. 11. The Japanese Study Group for Hirshsprung's disease; Department of Pediatric Surgery, Reproductive and Developmental Medicine, Faculty of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan. Electronic address: taguchi@pedsurg.med.kyushu-u.ac.jp.
Abstract
BACKGROUND/AIM: Although the mucosectomy-commencing points on transanal endorectal pull-through (TAEPT) differ among reports, the optimal point is unclear. This study assessed the outcomes among different mucosectomy-commencing points. METHODS: We conducted a nationwide survey from 2008 to 2012. The data of 1,087 Hirschsprung's disease patients were collected, and data on those who underwent TAEPT were extracted. The patients were divided according to the mucosectomy-commencing points into two groups: in Group A, mucosectomy was started ≥5 mm from the dentate line (DL), and in Group B, mucosectomy was started <5 mm from the DL. The extent of the aganglionic segment and postoperative complications in the month after TAEPT were compared. RESULTS: The data of 327 patients were extracted (Group A, n=155; B, n=172). Aganglionosis extending to the sigmoid colon was the most frequent in both groups. Regarding postoperative complications, the patients of each group experienced enterocolitis (Group A: 8.4%; B: 7.6%) and incontinence (A: 3.9%; B: 2.9%). The incidence of rectal mucosal prolapse was significantly greater in Group B (4.1%); (A: 0%, p=0.02). CONCLUSIONS: Although the outcomes of TAEPT were comparable in both groups, rectal mucosal prolapse was significantly frequent in patients in whom the commencing point was <5 mm from the DL. TYPE OF STUDY: Retrospective study LEVEL OF EVIDENCE: Level III.
BACKGROUND/AIM: Although the mucosectomy-commencing points on transanal endorectal pull-through (TAEPT) differ among reports, the optimal point is unclear. This study assessed the outcomes among different mucosectomy-commencing points. METHODS: We conducted a nationwide survey from 2008 to 2012. The data of 1,087 Hirschsprung's diseasepatients were collected, and data on those who underwent TAEPT were extracted. The patients were divided according to the mucosectomy-commencing points into two groups: in Group A, mucosectomy was started ≥5 mm from the dentate line (DL), and in Group B, mucosectomy was started <5 mm from the DL. The extent of the aganglionic segment and postoperative complications in the month after TAEPT were compared. RESULTS: The data of 327 patients were extracted (Group A, n=155; B, n=172). Aganglionosis extending to the sigmoid colon was the most frequent in both groups. Regarding postoperative complications, the patients of each group experienced enterocolitis (Group A: 8.4%; B: 7.6%) and incontinence (A: 3.9%; B: 2.9%). The incidence of rectal mucosal prolapse was significantly greater in Group B (4.1%); (A: 0%, p=0.02). CONCLUSIONS: Although the outcomes of TAEPT were comparable in both groups, rectal mucosal prolapse was significantly frequent in patients in whom the commencing point was <5 mm from the DL. TYPE OF STUDY: Retrospective study LEVEL OF EVIDENCE: Level III.