Clinical Defecation Function of Transanal Endorectal Pull-Through for Hirschsprung's Disease : Comparison With the Open Procedure (Z-Shaped Anastomosis)

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  • ヒルシュスプルング病に対する経肛門的根治術の術後排便機能 : 開腹池田Z法との比較
  • ヒルシュスプルングビョウ ニ タイスル ケイコウモンテキ コンチジュツ ノ ジュツゴ ハイベン キノウ カイフク イケダ Zホウ ト ノ ヒカク

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Abstract

Purpose: A transanal endorectal pull-through (TAEPT) procedure, which does not require any abdominal operation or laparoscopic assistance, has been advocated recently for Hirschsprung's disease. However, sufficient evaluation has not been made of the clinical defecation function. The aim of this study was to evaluate the clinical defecation function of short-segment aganglionosis, where TAEPT was performed following the Soave method, in comparison with conventional open Z-shaped anastomosis. Materials and Methods: The subjects are 17 cases that underwent a TAEPT procedure for short-segment rectal or rectosigmoid aganglionosis from 1998 to 2003 (TAEPT group) and 10 cases that underwent the open Z-shaped anastomosis for short-segment rectal or rectosigmoid aganglionosis from 1990 to 1998 (open group). Each case was evaluated for the use of enemas and suppositories, the number of stools per day, perianal skin rash, occurrence of postoperative enterocolitis requiring hospital stay, and RI-defecogram and functional continence score. Results: Enemas were administered in two cases (11.8%) out of the 17 in the TAEPT group. In one of them, enemas were used only for a postoperative period of six months. In the other case, enemas have been used for a year biginning three years after the operation. Enemas were administered in six cases (60.0%) out of the 10 in the open group. In the TAEPT group, the frequency of stools per day declined gradually. Initially, It it was four to five times per day at the early postoperative stage, and became two to three times per day with the elapse of a postoperative year. In the open group, it was two to three times per day in the first postoperative year, and became less than once per day with the elapse of three to four postoperative years. A perianal skin rash developed in three cases out of the 17 in the TAEPT group, but it disappeared with the elapse of two years. In the open group, no patients had a perianal skin rash. Enterocolitis requiring hospital stay occurred in one TAEPT case and in two open group cases. An RI-defecogram was measured for five in the TAEPT group and five in the open group. The results of the RI-defecogram showed that the maximum capacity of the rectum in the TAEPT group was significantly smaller than that in the open group, and the required time for excretion in the TAEPT group tended to be shorter than that in the open group. Both three TAEPT group members and two open group members, similar to the excretion patterns of the corresponding groups, showed good functional continence scores. Three open group members that presented an excretion delay in the RI-defecogram did not have good functional continence scores. Conclusions: Although the TAEPT group recorded a larger number of stools per day at the early postoperative stage, judging from the use of enemas and suppositories, the subsequent frequency of stools per day, and the result of the RI-defecogram, the defecation function of TAEPT group was considered to be better than that of open group. In order to carry out sufficient postoperative defecation functional evaluation, further long-term observation is required.

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