Transanal endorectal vs. Duhamel pull-through for Hirschsprung's disease

Area of Science:

• Pediatric Surgery
• Gastroenterology
• Surgical Outcomes

Background:

• Hirschsprung's disease (HD) is a congenital condition affecting the large intestine.
• Surgical intervention is necessary to treat HD.
• Two common surgical approaches are the Duhamel pull-through and the transanal endorectal pull-through (TERPT).

Purpose of the Study:

• To compare the early functional outcomes of the Duhamel pull-through and TERPT procedures for rectosigmoid Hirschsprung's disease.
• To evaluate postoperative patient discomfort and recovery.
• To test the hypothesis that TERPT offers comparable or superior early functional outcomes with less postoperative discomfort.

Main Methods:

• A prospective study of 11 patients undergoing TERPT (T Group) compared retrospectively with 18 patients who had the Duhamel procedure (D Group).
• Data collected included demographics, operative details, complications, hospital stay, and bowel function.
• Follow-up was limited to 24 months.

Main Results:

• The TERPT group experienced earlier oral feeding, bowel movements, and required less analgesia.
• The TERPT group had a significantly shorter hospital stay and a lower re-intervention rate (18% vs. 71%).
• While enterocolitis occurred in both groups, the TERPT group showed lower rates of constipation and soiling postoperatively.

Conclusions:

• The transanal endorectal pull-through (TERPT) procedure demonstrates superior early functional outcomes compared to the Duhamel pull-through for rectosigmoid Hirschsprung's disease.
• TERPT is associated with reduced postoperative morbidity, including shorter hospital stays and fewer re-interventions.
• The findings support the increased adoption of the TERPT technique in managing rectosigmoid HD.