Transition zone pull-through in Hirschsprung's disease: a tertiary hospital experience

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Updated: Mar 15, 2026

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Dhruva N Ghosh1, Yingrui Liu1, Daniel T Cass1

  • 1Department of Surgery, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.

ANZ Journal of Surgery
|September 2, 2016
PubMed

Insights

Pull-through of ganglionic bowel is crucial for Hirschsprung's disease treatment. Transition zone pull-through, though not requiring redo surgery in this study, is an error that should be prevented.

Area of Science:

  • Pediatric Surgery
  • Gastroenterology
  • Medical Histopathology

Background:

  • Successful Hirschsprung's disease treatment relies on ganglionic bowel pull-through.
  • This study investigates the incidence and outcomes of transition zone pull-through versus ganglionic bowel pull-through.

Purpose of the Study:

  • To determine the incidence of transition zone pull-through in Soave's pull-through procedures for Hirschsprung's disease.
  • To compare the outcomes and complications of transition zone pull-through with standard ganglionic bowel pull-through.

Main Methods:

  • Retrospective review of 50 patients undergoing Soave's pull-through for Hirschsprung's disease (Jan 2005 - Nov 2012).
  • Patients categorized into ganglionic bowel pull-through (Group 1) and transition zone pull-through (Group 2).
  • Analysis of demographics, clinical presentation, surgical details, histopathology, post-operative results, and complications.

Main Results:

  • 16% (8/50) of cases involved transition zone pull-through, often due to errors in histologic interpretation, sampling, or surgical technique.
  • The transition zone was significantly longer in Group 2 (P = 0.002).
  • Constipation and enterocolitis were primary complications; one patient in Group 2 required surgery for obstruction.

Conclusions:

  • Transition zone pull-through is associated with a significantly longer transition zone.
  • While redo surgery was not required in this cohort, the potential for future complications remains.
  • Transition zone pull-through is considered an error and strategies to prevent it are essential.
Abstract

Keywords:
Hirschsprung's diseaseconstipationenterocolitistransition zone

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