Clinical and manometric evaluation of postoperative anorectal function in patients after trans-anal pull-through for Hirschsprung disease

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Abstract

Background
Transanal endorectal pull-through (TEPT) surgery is a new trend in the treatment of Hirschsprung disease, and evaluating its functional outcome is difficult. The purpose of this study is to evaluate the defecation pattern after TEPT surgery in pediatrics.
Material and methods
In this cross-sectional survey, 40 patients with Hirschsprung disease were studied. They underwent a one-stage transanal pull-through procedure from May 2007 till April 2015 in Namazi hospital by the same surgeon. All the patients had the aganglionic segment in the rectosigmoid, confirmed by pre-operation barium enema and post-operation histopathology. The patients were 40 children with mean operation age of 36.6 months old. The success rate of surgery was evaluated by following the questionnaire form. Clinical evaluation with bowel function score and anorectomanometry were carried out.
Result
One hundred percent of them had a daily stool. Eighty-five percent of patients never experienced pain during defecation, 10% experienced occasional pain, and the rest felt pain with every defecation. Just one case (5%) reported using a laxative. Regarding improvements after the operation, 75% were completely okay, 20% felt much better, and 5% reported some improvements. The average National Health Service score was 8.375, which seems satisfactory. The mean average anal sphincter in the group with soiling was 39.67 and in the group without soiling was 34.83, which is in the normal range in both groups, and there was no significant difference between these groups ( > 0.05).
Conclusion
The defecation pattern after TEPT surgery were satisfactory in almost all cases, even in infancy. Most patients had satisfactory manometry and clinical result.

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