The outcomes of transanal endorectal pull-through for Hirschsprung's disease according to the mucosectomy-commencing points: A study based on the results of a nationwide survey in Japan

Background/Aim: Although the mucosectomy-commencing points on transanal endorectal pull-through (TAEPT) differ among reports, the optimal point is unclear. This study assessed the outcomes among different mucosectomy-commencing points. Methods: We conducted a nationwide survey from 2008 to 2012. The data of 1,087 Hirschsprung's disease patients were collected, and data on those who underwent TAEPT were extracted. The patients were divided according to the mucosectomy-commencing points into two groups: in Group A, mucosectomy was started ≥ 5 mm from the dentate line (DL), and in Group B, mucosectomy was started < 5 mm from the DL. The extent of the aganglionic segment and postoperative complications in the month after TAEPT were compared. Results: The data of 327 patients were extracted (Group A, n = 155; B, n = 172). Aganglionosis extending to the sigmoid colon was the most frequent in both groups. Regarding postoperative complications, the patients of each group experienced enterocolitis (Group A: 8.4%; B: 7.6%) and incontinence (A: 3.9%; B: 2.9%). The incidence of rectal mucosal prolapse was significantly greater in Group B (4.1%); (A: 0%, p = 0.02). Conclusions: Although the outcomes of TAEPT were comparable in both groups, rectal mucosal prolapse was significantly frequent in patients in whom the commencing point was < 5 mm from the DL. Type of study: Retrospective study Level of evidence: Level III