Efficacy of total transanal laparoscopic pull‑through and pure transanal endorectal pull‑through in the treatment of common‑type Hirschsprung disease.

Abstract

Introduction: Hirschsprung disease (HD) is a birth defect in which some of the intestinal nerve cells (ganglion cells) do not form completely. Improvements in laparoscopic skills among pediatric surgeons, along with technological advancements, have led to the widespread use of the natural orifice transluminal endoscopic surgery (NOTES) technique; however, reports on long-term outcomes and high-quality follow-up data on anorectal manometry in patients treated with this approach are scarce.

Aim: We aimed to compare the short-term and long-term efficacy of 2 surgical approaches to the treatment of common-type HD: total transanal laparoscopic pull-through (TTLP, which falls under the category of NOTES), and pure transanal endorectal pull-through (PTEP; not classified as NOTES) in order to provide a reference for clinical strategy selection.

Materials and methods: We retrospectively evaluated clinical data and follow-up results of 60 children with common-type HD who underwent TTLP or PTEP. The patients were divided into 2 equal-size groups according to the treatment method. Perioperative parameters were recorded, and regular follow-up was conducted by designated staff for over 10 years. The frequency and type of postoperative short- and long-term complications, pre- and postoperative anorectal manometry data, and daily bowel movement frequencies were recorded. The postoperative defecation function and quality of life scores were assessed and compared.

Results: The mean (SD) age of patients undergoing surgery was 16.75 (12.82) months in the TTLP group and 18.92 (11.55) months in the PTEP group. The incidence of perioperative and long-term complications did not differ between the groups. One month postsurgery, the TTLP group showed lower values of anorectal manometry indicators, as compared with the PTEP group. At 1 to 10 years postsurgery, except for lower anal resting pressure values in the TTLP patients, there was no significant difference in the anorectal manometry indicators between the groups. Both early and late postoperative defecation frequencies were similar between the 2 types of surgeries. Within the first 6 months postsurgery, the defecation function scores were higher in the TTLP group than in the PTEP group; however, after 1 year, there were no significant differences in these scores between the groups. The quality of life scores of the 2 groups showed no difference in the first 1 to 2 years of the surgery. However, the mean quality of life scores evaluated from 2 to 10 years postsurgery were higher in the TTLP group than in the PTEP group.

Conclusions: TTLP for common-type HD not only contributes to early postoperative recovery, but also enhances the long-term quality of life, as compared with PTEP.