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    • Stricture after Assisted and Non-Assisted Transanal Pull-through for Classic Hirschsprung’s Disease

    Wael Ahmed Ghanem, Ahmed Bassiouny Radwan
    Pediatric Surgery Department, Ain-Shams University, Egypt

    Background: Transanal endorectal pull-through (TEPT), and abdominally assisted TEPT for Hirschsprung’s disease (HSD) have been reported as established methods of treatment. However, the difference between the 2 procedures in the development of stricture has been scarcely reported. The purpose of this study was to compare the stricture formation after the assisted and non assisted TEPT. Methods: In the period between June 2009 and January 2012, 20 cases of classic HSD underwent abdominal assisted (group 1), (either by mini-laparotomy (group 1A, 14 cases) or laparoscopy (group 1B, 6 cases)) TEPT, and another 20 cases underwent Pure TEPT (group 2). There was no difference in age (<2years) and weight distribution between the 2 groups at the time of operation. Postoperative (PO) stricture development was assessed by the occurrence of buttocks excoriations and its duration, calibration by Hegar dilators at 2 weeks postoperative. A score from 0-2 were given for all the patients after 2 weeks (no stricture: 0, stricture: 1; tight stricture: 2). All patients were minimally followed up for 1 year. Results: No stricture developed in (55.56%) of group 1, and (45%) in group 2. Mild stricture occurred in (44.44%) of group 1 while it was (45%) in group 2. No patient (0%) of group 1 developed tight strictures, but (10%) of group 2 had tight stricture. None of our patients required surgical intervention for the stricture management. Conclusions: Assisted TEPT has clinically significant less incidence of post-operative development of stricture than non assisted TEPT. Key Words: Transanal endorectal pull-through, Hirschsprung’s disease, minilaparotomy, laparoscopy, stricture, obstructive score.

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