***TASK*** the task is to summarize an input biomedical literature in six sentences 
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    Input: PURPOSE Transanal endorectal pull-through ( TEPT ) has drastically changed the treatment of Hirschsprung 's disease ( HD ) . A short follow-up of children su bmi tted to TEPT  reveals results that are similar to the classic transabdominal pull-through procedures . However , few reports compare the late results of TEPT with transabdominal pull-through procedures with respect to complication rates and the fecal continence . The aims of the present work are to describe some technical refinements that we introduced in the procedure and to compare the short and long-term outcome of TEPT with the outcomes of a group of patients with HD who previously underwent the Duhamel procedure . METHODS Thirty-five patients who underwent TEPT were prospect ively studied and compared to a group of 29 patients who were treated with colostomy followed by a classical Duhamel pull-through .  The main modifications introduced in the TEPT group were no preoperative colon preparation , operation conducted under general anesthesia in addition to regional sacral anesthesia , use of only one purse-string suture in the rectal mucosa before transanal submucosal dissection , and no use of retractors and electrocautery during the submucosal dissection . RESULTS The most frequent early complications of TEPT group were perineal dermatitis ( 22.8 % ) and anastomotic strictures ( 8.6 % ) . The comparison with patients who underwent Duhamel procedure revealed no difference in the incidence of preoperative enterocolitis , the patients of the TEPT group were younger at the time of diagnosis and of surgery , they had shorter operating times , and they began oral feeding more quickly after the operation . The incidence of wound infection was lower in the TEPT group . Moreover , the TEPT and Duhamel groups showed no difference in the incidences of mortality , postoperative partial continence , and total incontinence . Although the incidences of complete continence and postoperative enterocolitis were not different , a tendency to the increased incidence in the TEPT group was observed . CONCLUSIONS This study further supports the technical advantages , the simplicity , and the decreased incidence of complications of a primary TEPT procedure when compared to a classical form of pull-through . Some technical refinements are described , and no preoperative colon preparation was necessary for the patients studied here . The results show that the long-term outcomes of the modified TEPT procedure are generally better than those obtained with classical approaches Transanal one-stage endorectal pull-through ( TOSEPT ) has been presented as the most recent progression in treatment of Hirschsprung ’s disease ( HD ) , which may be able to replace various previous techniques . This prospect i ve study was design ed to compare the efficacy and probable complications of the commonly used open surgery with those of TOSEPT technique in management of HD . Forty-two children ( 35 boys and 7 girls ) between 3 days and 12 years of age underwent surgical treatment for HD — all after being diagnosed by barium enema over an 18-month period . In a manner of systematic r and om selection , 21 patients were operated by TOSEPT and the other 21 by Swenson procedures .  All patients were followed-up at least for 12 months after hospital discharge . The necessary data containing age , sex , length of the resected aganglionic segment , intraoperative details , duration of hospital stay and postoperative functional results or complications were collected during hospitalization and follow-up period . There was no significant difference in age at the first operation , sex distribution and length of resected bowel between the two groups . Rate of postoperative complications were significantly higher in Swenson procedure group ( P < 0.01 ) . Narcotics were needed in all patients of Swenson procedure group but only in two patients operated by TOSEPT also required laparotomy ( P < 0.001 ) . The hospitalization period of TOSEPT group was also less than that of Swenson group ( P < 0.001 ) . The total cost of treatment by Swenson procedure is considerably higher than by TOSEPT . TOSEPT can significantly diminish postoperative pain , surgical complications , hospital stay and cost burden caused by Hirschsprung ’s disease . Besides , this procedure is cosmetically preferable because no visible scar remains AIM Our aim was to examine the long-term bowel dysfunction that followed surgery for Hirschsprung 's disease . METHODS Of 414 patients diagnosed with Hirschsprung 's disease between 1974 and 2002 , 98 were interviewed using a structured question naire to provide an assessment of bowel function , medication , diet , physical and social limitations . Forty-two completed a prospect i ve 4-week toileting diary and 16 underwent anorectal manometry . RESULTS Four of the 98 patients had permanent stomas and 10 had Down 's syndrome . Of the remaining 84 patients ( mean age 12 + /- 8 years , range 1.9 - 41.9 years ) , 13 % ( 11/84 ) had heavy soiling by day and 17 % ( 14/84 ) by night . Fifty percent reported episodic urgency , but 36 % also reported episodic constipation . Stool consistency was looser in patients with a history of long segment disease . Some aspects of bowel function improved with age . Enuresis was much more frequent than expected . Sixty-four percent reported adverse reactions to foods , particularly to fruit , vegetables , fats and diary products , and 15 % limited their social activities because of fecal incontinence . There were no significant differences in manometric parameters between those patients who soiled and those who did not . CONCLUSIONS Fecal incontinence is common after surgery for Hirschsprung 's disease and has a significant impact on social activities . Some aspects of bowel function did improve with age . Adverse reactions to food were unexpectedly frequent and need to be further studied PURPOSE The reported incidence of Hirschsprung's-associated enterocolitis ( HAEC ) is extremely variable . A st and ardized definition would permit comparison of different studies and provide an interpretable outcome measure for future prospect i ve studies in patients with Hirschsprung 's disease . METHODS The Delphi method is a technique for achieving consensus among a panel of experts . A list of 38 potential criteria from the history , physical examination , radiologic studies , and pathologic specimens was made available to pediatric surgeons and gastroenterologists who have contributed to the literature on Hirschsprung 's disease . Each expert ranked the diagnostic importance of each item using a Likert scale . In subsequent surveys , the same process was used , but the means and SDs from previous rounds were included as a way of influencing the experts toward consensus . Cronbach 's alpha was used after each round to measure variability among the experts . Once consensus was reached , an overall " HAEC score " was developed by assigning a value of 1 or 2 to each item that was considered important by the expert panel . The score was then vali date d by circulating 10 clinical cases to the panel and asking if each represented HAEC or not . RESULTS Twenty-seven experts completed the survey .  Cronbach 's alpha increased from 0.93 after the first round to 0.97 after the second . Criteria receiving the highest scores were diarrhea , explosive stools , abdominal distension , and radiologic evidence of bowel obstruction or mucosal edema . Eighteen items were included in the score . During the validation process , the score agreed with the experts in 9 of the 10 case scenarios . CONCLUSION The most important clinical diagnostic criteria for HAEC were identified from a larger pool of potential diagnostic items through a consensus approach using the Delphi method . A score was developed and vali date d and can now be used as a st and ardized and reproducible outcome measure for future studies in children with Hirschsprung 's disease PURPOSE A new endorectal pull-through technique using a transanal approach is presented in this report . METHODS  Mucosectomy , colectomy , and pull-through  are performed transanally , and neither laparotomy or laparoscopy are required . Five patients affected with Hirschsprung 's disease have been operated on with this technique . CONCLUSION During the 6- to 15-month follow-up period , all of them have had postoperative normal bowel movements AIM To evaluate the indications , results , and complications of Transanal Endorectal Pull-Through ( TEPT ) in the management of rectosigmoid Hirschsprung 's disease ( HD ) compared with the open technique . PATIENTS AND METHODS Between November 1998 and March 2002 , 68 Transanal Endorectal Pull-Through ( TEPT ) procedures were performed in infants and children . The patients ' ages ranged from 6 days to 13 years . The primary diagnosis in all 68 patients was Hirschsprung 's disease confined to the rectosigmoid region . All children were operated without construction of a pre-operative colostomy except for one patient . Follow-up period ranged from 6 - 46 months ( mean 32 months ) . These patients were compared with fifty patients who had undergone open pull-through for HD during the period from November 1995 to October 1998 . RESULTS AND COMPLICATIONS For the TEPT group , the mean operating time was 90 min and the average length of resected bowel was 25 cm . Sixty-two patients had satisfactory results without complications . Blood transfusion was needed in eleven patients only . Recovery was very fast and patients were often hungry within 24 hours . Feeding was resumed within 48 hours . One patient required laparotomy during the procedure due to injury to the urethra . Two patients required colostomy 3 and 5 days after surgery because of delayed leakage . Three patients suffered from attacks of enterocolitis 6 - 9 months postoperatively . There was increased frequency of defecation ( 5 - 15 times daily ) for 4 - 6 weeks after surgery in all patients . There was no constipation , no incontinence , no cuff abscess and no mortality in any of the patients . Average frequency of defecation was 1 - 3 times daily after 3 months postoperatively . For the open technique group , mean operating time was 150 min , the length of the average resected segment was 29 cm . Forty-one patients had satisfactory results without complications . The cost of the open technique was almost double that of the TEPT ( 6300 vs. 3200 pounds ) . CONCLUSIONS Transanal Endorectal Pull-Through ( TEPT ) is characterized by a shorter operating time , less bleeding , shorter hospital stay , less morbidity and earlier recovery than similar open pull-through procedures . The hazards and morbidities associated with laparotomy and colostomy may be avoided with a one-stage technique in Hirschsprung 's disease confined to the rectosigmoid area ( 70 - 80 % ) . Careful long-term follow-up is required to assess continence and sexual function BACKGROUND The transanal one-stage endorectal pull-through operation for Hirschsprung 's disease is relatively new and makes assessment of the functional outcome and colonic motility difficult . The aim of this study was to evaluate the stooling patterns and colonic motility after a one-stage transanal pull-through operation for Hirschsprung 's disease in children . METHODS Twenty-two children who underwent a one-stage transanal pull-through operation for Hirschsprung 's disease were followed up for at least 6 months . The children ( 17 boys and 5 girls ) were from 12 months to 13 years of age ( mean age , 4 years ) . All patients had an aganglionic segment confined to the rectosigmoid area ( confirmed by preoperative barium enema and postoperative histology ) . Clinical outcome was assessed by interviews and question naires , and children were divided into symptomatic and nonsymptomatic groups . Contrast barium enema and defecography and determination of total and segmental colonic transit time ( using radio-opaque markers ) were performed on all 22 children . RESULTS The stooling patterns were considered satisfactory in 17 children . Of all the children , the mean stool times were 1 to 2 per day and only 2 were 8 to 10 per day ; postoperative soiling was found in 4 , constipation was observed in 2 , and Hirschsprung-associated enterocolitis in 1 . There was no incontinence , cuff infection , anastomotic leak , or mortality noted . Barium enema showed that the dilated and spastic colonic segment disappeared in all 22 children . The dilated sigmoid loops decreased in 17 ( 2 symptomatic , 15 nonsymptomatic ) and disappeared in 5 ( 4 symptomatic , 1 nonsymptomatic ) . There was a significant difference between the decreasing and disappearing loop group in regard to stooling disorders ( P < .05 ) . Postoperative defecography showed that the anorectal angle of all children was open , fixed , and significantly larger than that of the preoperative and control groups ( 123.3 degrees + /- 15.1 degrees vs 84.7 degrees + /- 8.3 degrees vs 79.0 degrees + /- 11.6 degrees , P < .01 ) and larger in the symptomatic group when compared with the nonsymptomatic group ( 135.6 degrees + /- 15.9 degrees vs 111.0 degrees + /- 14.3 degrees , P < .05 ) . Postoperatively , the total gastrointestinal transit time , left colonic transit time , and rectosigmoid colonic transit time of all the children were shorter than preoperatively ( 26.8 + /- 8.2 vs > 188 hours , P < .01 ; 6.3 + /- 4.1 vs > 60 hours , P < .01 ; 11.8 + /- 4.4 vs > 120 hours , P < .01 ) and similar to controls . The total gastrointestinal transit time and rectosigmoid colonic transit time of the symptomatic group were significantly shorter than the nonsymptomatic group ( 25.2 + 
    Output:
    
We could show a significant advantage of L-TERPT/TERPT over OPEN surgery regarding the incidence of soiling/incontinence and constipation .
No differences were seen for enterocolitis and anastomotic stricture .
We conclude from our data that L-TERPT/TERPT represents a valid option in the treatment of HD and might have some advantages over the OPEN techniques .