Fecal incontinence after single-stage Soave’s pull-through: abdominal versus transanal endorectal pull-through

Abstract

Purpose To compare the postoperative fecal continence and bowel functions between patients who underwent a single stage - Soave’s endorectal pull through operations whether via the classic abdominal endorectal pull through approach (TAPT) or trans-anal endorectal pull through approach (TERPT).
Patients and Methods This retrospective study was performed on 50 HD consecutive patients who had undergone surgery during a period of 5 years from January 2002 to January 2007. They were two equal groups; group I (n=25) including patients who underwent TAPT; group II (n=25) including patients who underwent TERPT. Demographic, clinical data, preoperative investigations, operative records, postoperative outcome were studied. Post operative fecal continence score rate (FCSR) was assessed in children over the age of 4 years. Moreover, those with poor FCSR were further investigated by magnetic resonance imaging (MRI). Electromyography (EMG) and anorecatal manometery (AM) were also used in follow-up.
Results Twenty six patients (52%) had an excellent FCSR and eighteen patients (36%) showed good FCSR. However, 5 patients (10%) had a fair FCSR and only 1 patient (2%) suffered of a poor FCSR. There was no statistical significant difference between the two groups in neither anal manometry nor EMG. MRI did not show any abnormalities on pelvic floor and anal muscle complex on those patients who had fair or poor FCSR.
Conclusion The incidence of fecal incontinence is very low after Soave’s pull-through operations whether TAPT or TERPT approaches with no statistical significant difference.

Keywords: fecal continence, Hirschsprung’s disease, Soave’s operation, transanal endorectal pull-through