Transanal endorectal pull-through for Hirschsprung disease: technique, controversies, pearls, pitfalls, and an organized approach to the management of postoperative obstructive symptoms

The transanal endorectal pull-through emerged in the late 1990s as the most recent step in the evolution of the surgical correction of Hirschsprung disease. This operation provides the advantages of a minimal access approach with shorter hospital stay, shorter time to full feeding, less pain, and im...

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Bibliographic Details
Published in:Seminars in pediatric surgery 2010-05, Vol.19 (2), p.96-106
Main Authors: De La Torre, Luis, MD, Langer, Jacob C., MD
Format: Article
Language:English
Subjects:
Algorithms
Anal Canal - pathology
Anal Canal - surgery
Anastomosis, Surgical
Botulinum toxin
Child
Colostomy - methods
Constriction, Pathologic
Digestive System Surgical Procedures - methods
Dissection - methods
Enterocolitis
Hirschsprung Disease - surgery
Humans
Internal sphincter achalasia
Intestinal Obstruction - surgery
Length of Stay
Minimally Invasive Surgical Procedures
Pediatrics
Perineal pull-through
Postoperative Care
Postoperative Complications - epidemiology
Postoperative Complications - therapy
Prone Position
Reoperation - methods
Soave
Surgery
Suture Techniques
Swenson
Transanal pull-through
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Summary:The transanal endorectal pull-through emerged in the late 1990s as the most recent step in the evolution of the surgical correction of Hirschsprung disease. This operation provides the advantages of a minimal access approach with shorter hospital stay, shorter time to full feeding, less pain, and improved cosmesis with excellent outcomes. This article will review the technical principles of the transanal endorectal pull-through, and will address ongoing controversies in the application of this technique. We will also discuss an organized approach to the problem of obstructive symptoms that may affect a subgroup of patients after the transanal pull-through.
ISSN:1055-8586
1532-9453
DOI:10.1053/j.sempedsurg.2009.11.016