Stooling and manometric findings after primary pull-throughs in Hirschsprung's disease: Perineal versus abdominal approaches.

BACKGROUND/PURPOSE: Primary pull-through via a perineal approach (PA) has recently been reported for Hirschsprung's disease. One criticism of this approach is that it requires a large amount of retraction on the anal sphincters. Additionally, because the procedure is new, most patients undergoing a PA are too young to assess long-term continence rates. This study examined early stooling patterns, anal sphincteric pressures, and number of enterocolitic episodes in infants who underwent a PA. Results were compared with a conventional combined transabdominal and perineal approach (TA).

METHODS

Over 2 years, 26 pull-through procedures were performed. Nine of those were PA, and 17 were TA. Twelve of the 26 patients had formal manometric studies postoperatively. Results are expressed as mean +/- SD; unpaired t test and Chi;(2) were used for statistical analysis.

RESULTS

Mean follow-up post-pull-through was 23 +/- 2.3 months for the TA and 14 +/- 1.9 months for the PA. Manometric resting sphincter pressure in the TA group averaged 79 +/- 17 mm Hg compared with 76 +/- 21 mm Hg in the PA group (P =.78). Number of stools per day was 3.3 +/- 0.6 in the TA group compared with 2.2 +/- 0.3 in the PA group (P =.17). Post-pull-through enterocolitis was experienced by 53% of the TA group (mean, 1.5 +/- 0.6 episodes) and 56% of the PA group (mean 0.9 +/- 0.4 episodes) for a P =.08 by Chi;(2) analysis.

CONCLUSIONS

Manometric sphincter pressure and enterocolitic episodes after a PA for Hirschsprung's disease appear to be similar to results obtained with a conventional TA. Evaluation of early stooling frequency shows a comparable frequency after a PA. This suggests that both methods are safe, and the PA does not appear to compromise sphincter integrity.