One-Stage Posterior Transanal Rectal Myomectomy for Short-segment Rirschsprung disease in Children: A Feasible Day-case Procedure with Good Surgical and Functional Outcome
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Objectives: To evaluate the surgical and functional outcome of one-stage transanal rectal myomectomy in children had short-segment Hirschsprung disease (HD) Patients & Methods: The current selective study included 14 children presented with chronic constipation and barium studies detected short- or ultra-short aganglionic rectal segment. Manometry for estimation of resting rectal pressure was performed preoperatively and at 6-months postoperative (PO). Through transverse incision, at 6 o'clock, below the dentate line a strip of sphincteric circular muscle about 1 cm width and 3- 5 cm length was excised using ligasure diathermy and after assuring hemostasis direct closure of the mucosa was performed and temporary pack was applied to the wound. Operative data included operative time, amount of intraoperative bleeding or complications. Immediate postoperative data included time till oral intake, postoperative hospital stay. Defecation pattern questionnaire (DPQ) was scored preoperatively and at 3 and 6 months PO. Results: All patients passed uneventful intraoperative course with mean operative time of 41±6.5 minutes and mean intraoperative blood 1 dk S loss of 63.9±10.6 ml. Mean duration till 1st oral intake was 2.1±0.8 hours and mean duration of PO hospital stay was 6.1+0.9 hours. Mean total DPQ score at 6-m PO was significantly higher compared to that at 3-m PO. Individually, all patients showed progressive control on their bowel habits manifested as significantly higher total DPQ for each patient at 6- m compared to that determined at 3-m PO. Resting intrarectal pressure, at 6-m PO, was significantly lower compared to preoperative pressure and non-significantly lower compared to control children. Conclusion: One-stage transanal posterior rectal myomectomy is feasible, safe and effective therapeutic modality for HD patients with short aganglionic segment. Functional outcome as judged by DPQ showed progressive improvement and good quality of life at 6 months PO for all studied patients.