Single-stage transanalendorectalpull-through procedure for correction of Hirschsprung disease in neonates and non-neonates: A multi-center study

Abstract Purpose The outcomes of single-stage transanal endorectal pull-through (SSTEPT) for Hirschsprung disease(HSCR) in young patients are favorable; however, reports have shown that diagnosis and surgery at young ages increase the risk for post-operative enterocolitis and slows post-operative recovery. The present study was primarily designed to evaluate the outcomes of SSTEPTin a multi-institutional cohort of neonates and non-neonates with HSCR. Methods Between August 2005 and May 2012, a total of 650 children with HSCR were divided into the following two groups: group A(neonatal group, operative age < 28 days [n = 186]); and group B(non-neonatal group, operative age > 28 days [n = 464]).The short-term outcomes were post-operative enterocolitis, perianal excoriation, and anastomotic stricture and leakage rates. The mid-term outcomes were incomplete continence and constipation rates based on multi-institutional chart review. Statistical analyses were performed using chi-square(χ2 )tests. Results Follow-up was completed in 112 neonates and 303 non-neonates. Short-term outcomes indicated a higher incidence of perianal excoriation (27.6% vs. 6.6%,χ2 = 33.70, p < 0.05), anastomotic strictures (14.3% vs. 6.0%,χ2 = 27.18, p < 0.05), anastomotic leakage(8.0% vs. 1.7%,χ2 = 8.36, p < 0.05), and post-operative enterocolitis (40.2% vs. 10.2%,χ2 = 49.05, p < 0.05) in group A compared to group B. Mid-term outcomes indicated a higher incidence of incomplete continence(35.7% vs. 14.9%,χ2 = 21.85, p < 0.05) in group A compared to group B. Conclusion Performing single-stage transanal endorectal pull-through in the non-neonatal period may be more appropriate than the neonatal period. There were higher rates of perianal excoriation, anastomotic strictures and leakage, post-operative enterocolitis, and incomplete continence post-operatively in neonates than non-neonates.