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Transanal, full-thickness, Swenson-like approach for Hirschsprung disease.
[hirschsprung disease]
Swenson
's
procedure
for
Hirschsprung
disease
(
HD
)
was
thought
to
disturb
fecal
,
urinary
,
and
ejaculatory
functions
leading
to
other
approaches
including
the
Soave
and
Duhamel
techniques
.
Given
our
Center
's
experience
with
a
full-thickness
rectal
dissection
for
anorectal
malformations
,
and
using
the
new
transanal
concept
,
we
chose
to
apply
these
ideas
to
the
primary
treatment
of
HD
,
and
describe
technical
aspects
and
impact
on
fecal
,
urinary
,
and
sexual
function
.
We
reviewed
our
series
of
HD
patients
who
underwent
a
transanal
,
Swenson-like
rectosigmoid
dissection
,
assessing
for
postoperative
stricture
,
anastomotic
leak
,
enterocolitis
,
and
long
-term
results
for
bowel
,
urinary
,
and
sexual
function
.
Of
67
patients
,
28
had
a
transanal
resection
,
5
had
transanal
plus
laparoscopy
,
and
34
had
transanal
plus
laparotomy
,
of
those
,
28
patients
had
a
leveling
colostomy
prior
to
referral
.
The
average
length
of
resection
was
27
cm
±
12
.
7
cm
.
Mean
follow-up
was
17
.
2
months
(
range
1
-
96
months
)
.
44
patients
were
at
least
three
years
old
at
follow-up
and
were
assessed
for
urinary
and
fecal
continence
;
all
(
100
%
)
had
voluntary
bowel
movements
and
urinary
continence
.
Enterocolitis
occurred
in
9
patients
(
14
%
)
and
constipation
(
requiring
laxatives
)
occurred
in
21
(
32
%
)
.
Of
24
male
patients
,
21
(
88
%
)
reported
the
occurrence
of
spontaneous
erections
post-operatively
.
Our
data
support
the
fact
that
a
modification
of
Swenson
's
original
transabdominal
dissection
concept
using
the
recently
described
transanal
approach
is
an
excellent
technique
for
Hirschsprung
,
and
produces
excellent
long
-term
outcomes
for
fecal
and
urinary
continence
,
and
seems
to
preserve
erectile
function
.
Diseases
Validation
Diseases presenting
"primary treatment"
symptom
coats disease
hirschsprung disease
hydrocephalus with stenosis of the aqueduct of sylvius
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