Background: Several operative techniques have been developed for the treatment of Hirschsprung's disease (HD) in the past decades. One-stage trans-anal pull-through (TAPT) was first performed in 1998.
Objectives: To evaluate fecal continence after laparoscopicassisted and trans-anal endo-rectal pull-through (TERPT) for recto-sigmoid Hirschsprung's disease (HSD).
Patients and Methods: This prospective study was performed on 40 pediatric patients with Hirschsprung's disease from July 2013 to July 2016 at Al-Azhar University Hospitals. The patients were divided into two equal groups: group (A) underwent laparoscopic assisted trans-anal endo-rectal pull-through, and group (B) underwent pure trans-anal endo-rectal pull-through (TERPT). Demographic, clinical data, preoperative investigations, operative records, postoperative outcome were studied. A continence evaluation questionnaire (CEQ, max score = 10) assessing frequency of motions, severity of staining, severity of perianal erosions, anal shape, and requirement for medications was used. Severity of staining was graded as none = 2, occasional = 1.5, often = 1, and always =0. Electromyogram (EMG) and magnetic resonance imaging (MRI) were also used in follow-up.
Results: After one year of follow up , group A, continence score was normal in 10 (50%), good in 9 (45 %), and fair in 1 (5%); while group B, continence score was normal in 5 (25 %), good in 14 (70%), and fair in 1 (5%). However, staining/soiling in group A was present in 2(occasional staining); while group B, staining/soiling was present in 2(occasional staining). Statistically significant difference was found between groups according to continence score after 1month and 6 months, but no statistical significance clinically after 12 months.
Conclusion: Laparoscopically assisted trans-anal endo-rectal pull through was less invasive and can provide a better clinical outcome compared with trans-anal endo-rectal pull through as regard fecal continence and stooling function.