Long-Term Evaluation of Transanal Pull-Through For Hirschsprung Disease: A Prospective Study of 18 Cases from Senegal (Clinical Study)

Ndeye Aby Ndoye [1] , Faty Balla Lô [2] , Cheikh Seye [3] , Lissoune Cisse [2] , Ibrahima Bocar Welle [1], Youssouph Diehdiou [1], Oumar Ndour [4], Gabriel Ngom [1]

[1] Chirurgie pediatrique, Universite Cheikh Anta Diop de Dakar (UCAD), Hôpital d’enfants Albert Royer de Dakar, Senegal

[2] Chirurgie pediatrique, Hôpital National Pikine, Dakar Senegal

[3] Chirurgie pediatrique, Diourbel Regional Hospital Center Heinrich Lübke (CHRHL de Diourbel), Université Alioune Diop, Senegal

[4] Chirurgie Pediatrique, Hôpital Aristide Le Dantec (HALD), Dakar, Senegal

Keywords

Colonic aganglionosis

Congenital megacolon

Continence evaluation

Fecal continence

Hirschsprung disease

Abbreviations

HD - Hirschsprung disease

TAP - Transanal pull-through

Abstract

Introduction: Distal colonic aganglionosis is increasingly been treated with transanal pull-through that avoids a laparotomy. This study is intended to evaluate the results of this approach in a resource-limited setting.

Methods: This is a descriptive study done prospectively between 2016 and 2023 at the Albert Royer Children's Hospital, Dakar, Senegal. It includes 18 children operated upon exclusively by De la Torre-Mondragon’s technique of trans-anal pullthrough for Hirschsprung disease. Morbidity and anal continence were evaluated using the simplified Holschneider and Krickenbeck scores.

Results: The mean follow-up duration was 6 yr (range 4-7 yr). Immediate complications were diaper rash and anal fissures. According to the Holschneider scoring system continence was normal in 11 patients (61%), good in 5 (28%), and satisfactory in 2 (11%). However, occasional soiling was noted in 56%. According to the Krickenbeck score, continence was noted in 16 patients (89%), while 10 patients (56%) suffered from fecal incontinence and 4 patients (22%) from constipation. Three patients (17%) reported restricted social life as a direct consequence of impaired bowel function.

Conclusion: Transanal colonic pull-through may lead to long-term morbidity, such as soiling, which can significantly affect the quality of life