| Endorectal pull-through for Hirschsprung's disease-a multicenter, long-term comparison of results: transanal vs transabdominal approach. | |
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MedLine Citation:
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PMID: 20620323 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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PURPOSE: Previous studies have reported decreased continence in patients undergoing transanal endorectal pull-through (TERP) for Hirschsprung's disease compared to the older transabdominal approach (TAA). To address this, we examined long-term stooling outcomes in a large, multicenter cohort of patients undergoing either TERP or TAA. METHODS: Data were collected from 5 large pediatric institutions. Patient families were surveyed using a stooling score system (0-40, best to worst total score). Inclusion criteria included patients older than 3 years and those who had more than 6 months of recovery after pull-through. Those with total colonic aganglionosis were excluded. Statistical analysis included univariate and multivariate linear regression (significance, P < .05). RESULTS: Two hundred eighty-one patients underwent TERP (192) or TAA (89). Interviews were completed in 149 (104 [52%] TERP vs 45 [52%] TAA). The TAA group had a significantly greater number of daily bowel movements for each respective postoperative year and experienced more early complications (3% vs 1% with >1 complication; P = .061) and late complications (19% vs 4% with >1 complication; P < .001). Although the TAA group had a higher mean enterocolitis score (3.3 +/- 0.4 vs 1.8 +/- 0.2; P < .001), this was not borne out by multivariate regression analysis (P = .276). Parental survey showed that there were no significant differences between procedures in mean total, continence, or stooling pattern scores. CONCLUSION: Transanal endorectal pull-through was associated with fewer complications and fewer episodes of enterocolitis. In contrast to prior studies, TERP patients did not have a higher rate of incontinence. These results support use of TERP as an excellent surgical approach for children with Hirschsprung's disease. |
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Authors:
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Anne C Kim; Jacob C Langer; Aimee C Pastor; Lingling Zhang; Cornelius E J Sloots; Nicholas A Hamilton; Matthew D Neal; Brian T Craig; Erin K Tkach; David J Hackam; Nicolaas M A Bax; Patrick A Dillon; Jennifer N Chamberlain; Daniel H Teitelbaum |
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Publication Detail:
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Type: Comparative Study; Journal Article; Multicenter Study; Randomized Controlled Trial |
Journal Detail:
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Title: Journal of pediatric surgery Volume: 45 ISSN: 1531-5037 ISO Abbreviation: J. Pediatr. Surg. Publication Date: 2010 Jun |
Date Detail:
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Created Date: 2010-07-12 Completed Date: 2010-10-21 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0052631 Medline TA: J Pediatr Surg Country: United States |
Other Details:
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Languages: eng Pagination: 1213-20 Citation Subset: IM |
Copyright Information:
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Copyright 2010 Elsevier Inc. All rights reserved. |
Affiliation:
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Department of Surgery, Section of Pediatric Surgery, University of Michigan, Ann Arbor, Michigan 48109-0245, USA. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Child Child, Preschool Colonoscopy / methods* Defecation Dissection / methods* Female Follow-Up Studies Hirschsprung Disease / physiopathology, surgery* Humans Intestinal Mucosa / surgery* Laparoscopy / methods* Male Rectum / surgery* Retrospective Studies Time Factors Treatment Outcome |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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