Perineal one-stage pull-through for Hirschsprung's disease

Area of Science:

• Pediatric Surgery
• Gastroenterology
• Surgical Innovation

Background:

• Hirschsprung's disease (HD) is a congenital disorder characterized by the absence of ganglion cells in the distal bowel.
• Traditional surgical approaches for HD often involve multiple stages and transabdominal dissection.
• Minimally invasive techniques are being explored to improve outcomes for pediatric surgical conditions.

Purpose of the Study:

• To present a novel one-stage surgical strategy for Hirschsprung's disease using a transanal approach.
• To evaluate the feasibility and initial outcomes of this transanal one-stage repair (POOP procedure).

Main Methods:

• Ten neonates and one toddler with biopsy-proven HD underwent a transanal repair.
• The procedure involved mucosal dissection starting 0.5 cm proximal to the dentate line, allowing up to 15 cm of bowel resection.
• Ganglion cell presence was confirmed intraoperatively via frozen section analysis.

Main Results:

• The mean operative time was 105 minutes, with no intraoperative or postoperative complications.
• All patients achieved confirmed ganglion cell presence postoperatively.
• Mean hospital stay was 2 days, with patients averaging 3-6 bowel movements daily without requiring enemas.

Conclusions:

• The transanal one-stage operative pull-through (POOP) procedure is a safe and effective adaptation for Hirschsprung's disease.
• This technique offers a potentially simpler alternative to traditional staged repairs.
• Long-term follow-up is necessary to fully assess functional outcomes compared to conventional methods.