The Comparison of Functional Outcomes of Transanal Single Stage Endorectal Pull-Through and Staged Procedure (Soave) for Hirschsprung's Disease

Abstract

Aim: The aim of this study was to determine and compare functional outcomes of single stage transanal endorectal pull-through (TAP) and staged Soave procedure. Methods: Medical records of 41 patients (28 males, 13 females) who were operated on for Hirschsprung's disease between February 2004 and March 2007 were reviewed retrospectively. Three non-survived patients were excluded from study. No patient had total colonic aganglionosis. Demographic findings, type of surgery and length of hospital stay (LOS) were recorded for each patient. The parents were asked to fill a questionaire containing questions about quality of life, growth, nutrition, daily frequency of defecation, presence of enterocolitis, constipation and incontinance. Chi-square and Fisher 's exact tests were used to determine the difference between groups. Results: Single-stage TAP procedure was performed in 21, and, two- stage Soave procedure in 20 patients, respectively. Median LOS was shorter in TAP group (3 days) compared with staged Soave procedure group (7 days) (p<0.05). All of the patients showed normal growth and development. There were no stastistically significant differences between groups in terms of functional outcomes. Two cases (9.5 %) in thjr TAP, and 5 (25 %) in staged Soave group had fecal incontinence, while enterocolitis were seen in 5 (23.8 %), and 4 (20%) cases in the corresponding groups, respectively. One patient in each group had constipation (4.7 % and 5 %, respectively). Increase in defecation frequency was reported for 3 patients in each group (14.2 %, and 15 %, respectively). Conclusions: Single stage TAP and two stage Soave procedures have similar functional outcomes. Our study favors one- stage TAP over two- stage Soave procedures in terms of decreased LOS, better cosmesis and advantages related to single stage surgery.