Abstract:

Objective A retrospective study was performed to investigate the feasibility,safety and advantages of transanal one-stage pull-through for long segment Hirschsprung disease in infants.Methods The case reports of 39 consecutive children less than 3 years old undergoing Soave pull-through were reviewed.They were diagnosed as long segment Hirschsprung disease with contrast enema and suction rectal biopsy.Age,operating time and bleeding,complications,follow-up,and functional results were analyzed.Results In the transanal Soave pull-through group,one of a longer segment to liver zone led to the selective use of laparoscopy.The mean operation time was 107 min and mean resection colon was 58 cm.There were no complications post operation,such as enterocolitis,stricture or cuff narrowing.The patients tolerated feeding on the third post-operative day.The mean hospital stay after operation was 9.3 d. All patients were followed up in 1,3 and 6 months.After 6 months,all childrenhad 1～3 bowel movements per day.Conclusion The trans-anal one-stage pull-through procedure for most of long segment Hirschsprung disease is an easy adaptation to a well-described technique in infants,without an increased risk of complications.Because there is no intraabdominal dissection,there probably is a lower incidence of adhesive bowel obstruction.Transanal endorectal resection and pull-through technique minimizes blood loss in this study,and as effective as the open standard techniques.The most important is that the surgeons can identify the level of the transition zone histological before they begin the perineal dissection.

Key words: Hirschsprung disease, anus, Soave technique