Chulalongkorn Medical Journal


Background : Transanal endorectal pull-through (TEPT) has been widely used inthe treatment of Hirschsprung’s disease (HD). We have been using thistechnique as described by Mondrag n and Ortega - Salgado in ourhospital since January 2004.Objective : To evaluate the results of TEPT in the management of HD.Design : Retrospective study.Setting : Queen Sirikit National Institute of Child Health.Method : Fifty - three patients underwent TEPT for HD from January 2004 toMarch 2011. Patients’ hospital records were retrospectively analysed.The collected data included associated anomalies, age at diagnosis,enterocolitis before TEPT, weight at pull-through, site of transition zone,initial colostomy, primary TEPT without colostomy, age at pull-through,average length of resected bowel, operating time, blood loss, postoperativecomplications, daily bowel movements and continence. Follow-up periodranged from 2 weeks to 84 months.Results : The mean operating time was 210 minutes. Average length of resectedbowel was 13 cm. Average blood loss during operation was 24 cc.Transition zone was noted at rectosigmoid region in 36 patients (68%).Age at operation under six months was documented in 36 patients. Sevenpatients had anastomotic stricture managed by anal dilatation andadditional anoplasty in 1 case. Twenty-one patients suffered from attacksof enterocolitis postoperatively at least one time. Frequent bowelmovements gradually improved with time. Normal bowel function wasdocumented in 46 of 53 patients (87%).Conclusions : A one-stage pull-through for HD can be successfully performed using atransanal approach without intraperitoneal dissection. It takes less time,and has less bleeding, earlier recovery, less complication and no visiblescar. Careful long-term follow up is required to assess daily bowelmovements and continence.


Faculty of Medicine, Chulalongkorn University

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