Single Stage Transanal Endorectal Pull-Through (T.E.P.T) for Hirschsprung's Disease.

INTRODUCTION : Hirschsprung’s Disease (HD), named after Harold Hirschsprung, who presented the classic description in 1886, is a common cause of intestinal obstruction in pediatric age group. The incidence ranges from 1 in 4500 to 1 in 7000 live births, with 4:1 male to female ratio. It usually presents in the neonatal period or early childhood. Atypical presentation in adolescents and adults is not uncommon. Neonates usually present with delayed passage of meconium beyond 48 hours, abdominal distension and vomiting. Beyond neonatal period the presentation is that of chronic constipation, abdominal distension and failure to thrive. The exact etiology is not known, but the basic pathology lies in the failure or blockage of migration of neuroenteric cells from the neural crest to the alimentary tract. This results in absence of ganglion cells both in Meissner’s and Auerbach’s plexus of GIT. Moreover there is an increase in cholinergic and adrenergic excitatory innervations in the aganglionic segment. This leads to spastic, non-relaxing, non-peristaltic aganglionic segment causing obstruction. AIMS : 1. To evaluate the functional results in children with Hirschsprung’s Disease who had undergone Single Stage Transanal Endorectal Pull through. 2. To evaluate the stooling pattern post operatively in these patients. 3. To study the immediate and late complications. 4. To assess patient and parental satisfaction. MATERIALS AND METHODS : Inclusion Criteria: The following patients were included in the study. 1.Only classical type of Hirschsprung’s Disease. 2. No preliminary colostomy. 3.Patients with no evidence of perforation or enterocolitis at diagnosis. Exclusion Criteria: The following patients were not included in the study. 1.Patients with ultra short segment disease, long segment disease and total colonic aganglionosis. 2. Patients with prior colostomy. 3. Patients with evidence of perforation or enterocolitis. 4. Patients with obstruction not relieved by rectal irrigation. 5. Associated life-threatening anomalies. 6. Patients with more than 6 yrs of age. CONCLUSION : A number of operative strategies have been described for Hirschsprung’s disease. All are perceived to have relative merits and weakness, supported in some cases by medium and long term outcome data. Evaluation of different techniques is complex, and results of large single-surgeon series may reflect the merits of the surgeon rather than the operation. Randomized controlled trials are not feasible, and, where an institute has adopted a new technique, only historical comparison is possible. In contrast to establishing the safety of a new procedure, assessment of functional outcome is complicated. Lack of consensus regarding socially acceptable norms, relative insensitivity of questionnaire tools, and lack of generally accepted functional continence score all contribute to this. The inevitable delay between treatment and assessment of continence at age of 3 to 4 years prolongs the process of comparison. Initial results reported in literature after Single Stage Transanal Endorectal Pullthrough were very encouraging and results were comparable to the time tested staged procedures. The results were based on small sample size and relief of obstruction was considered as satisfactory outcome