Published in:
01-05-2016 | Original Article
The mid-term outcomes of TRM–PIAS, proctocolectomy and ileoanal anastomosis for total colonic aganglionosis
Published in: Pediatric Surgery International | Issue 5/2016
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Aims
The present study aimed to evaluate the mid-term outcomes of total colonic aganglionosis (TCA) after transanal rectal mucosectomy and partial internal anal sphincterectomy (TRM–PIAS), proctocolectomy and ileoanal anastomosis.
Patients and methods
From 2012 to 2014, 12 patients (7 boys; 58.3 %) diagnosed with TCA and treated with the TRM–PIAS, proctocolectomy and ileoanal anastomosis. Seven TCA patients who underwent laparotomy-assisted endorectal pull-through (LEPT) between 2010 and 2012 were used as control group. Demographic features and complication of the two groups were evaluated. The functional outcomes were assessed by using a score system.
Results
The procedure was successfully performed in all patients. The incidence of postoperative HAEC in the TRM–PIAS group was significantly lower (25.0 vs 85.7 %; p < 0.05) than control group within the second postoperative year. The number of bowel movement after 3, 12 and 24 months postoperatively, was 8.5 ± 3.5, 5.3 ± 2.9 and 3.1 ± 1.4 (p < 0.05) per day, respectively, in the TRM–PIAS group. The soiling was noted in 50.0 % (n = 6) of the patients in the 6th postoperative month, and 25.0 % (n = 3) in the 24th postoperative month in the TRM–PIAS group. There was no significant difference in overall functional outcome between two groups, but the TRM–PIAS group was better in terms of bowel movement and soiling.
Conclusion
TRM–PIAS, proctocolectomy and ileoanal anastomosis might be an effective treatment for TCA. More prospective studies evaluating the TRM–PIAS technique over longer period and with greater sample size are needed to confirm the findings in this study.