Transanal pull-through for Hirschsprung disease in neonates: A single-center experience
DOI:
https://doi.org/10.52783/jns.v12.1220Keywords:
Newborn, Hirschsprung disease, Primary transanal pull-through, OutcomeAbstract
Background: Transanal pull-through for the treatment of Hirschsprung disease in the neonatal period remains debatable. This study reported our experience with transanal pull-through in neonates.
Methods: We reviewed medical records of neonates with Hirschsprung disease treated in our department with transanal pull-through between the years 2010 and 2016.
Results: Of the 40 included patients, 31 were male neonates, and 9 were female. The mean age at the time of surgery was 13 days. The mean operative time was 136 minutes. The level of aganglionosis was rectal in 8 cases, rectosigmoid in 19 cases, descending colon in 7 cases, splenic flexure in 3 cases, transverse colon in 2 cases, and ascending colon in one case. A combined abdominal approach was used in 11 patients. There were no intraoperative complications. Major complications were noted in 4 cases: anastomotic leakage in 3 cases of whom one succumbed 3 days postoperatively; and bowel perforation in one case. The most common late postoperative complication was fecal soiling encountered in 25% of cases. Two among 29 patients who reached the age of continence remain incontinent.
Conclusion: Transanal pull-through in neonates has similar outcomes and complications to those of infants and children. Therefore this procedure can be safely employed in neonates however we recommend that the treating team should have an ample learning curve for this procedure in infants.
Downloads
Metrics
References
Anderson JE, Vanover MA, Saadai P, et al. Epidemiology of Hirschsprung disease in California from 1995 to 2013. Pediatr Surg Int. 2018; 34:1299–1303.
Lu C, Hou G, Liu C, et al. Single-stage transanal endorectal pull-through procedure for correction of Hirschsprung disease in neonates and non-neonates: a multicenter study. J Pediatr Surg. 2017; 52:1102–7.
Vũ PA, Thiện HH, Hiệp PN.Transanal one-stage endorectal pull-through for Hirschsprung disease: experiences with 51 newborn patients. Pediatr Surg Int. 2010; 26:589–92
Hassan HS. One-stage transanal endorectal pullthrough procedure for Hirschsprung’s disease in neonates. Ann Pediatr Surg. 2009; 5:21-26.
Negash S, Getachew H, Tamirat D, et al. Hirschsprung disease managed with one-stage transanal endorectal pullthrough in a low-resource setting without frozen section. BMC Surg. 2022; 22:89.
Georgeson KE, Cohen RD, Hebra A, et al. Primary laparoscopic-assisted endorectal colon pull-through for Hirschsprung’s disease: a new gold standard. Ann Surg. 1999; 229:678–82.
Kleinhaus S, Boley SJ, Sheran M, et al. Hirschsprung’s disease: A survey of the members of the surgical section of the American Academy of Pediatrics. J Pediatr Surg. 1979; 14:588-97.
Bhatiav P, Joshi SR, Ramji J, et al. Single stage transanal pull-through for Hirschsprung's disease in neonates: our early experience. J Neonatal Surg. 2013; 2:39.
Zhang Y, Liu Z, Li S, et al. One-stage transanal endorectal pull-through for Hirschsprung disease: experience with 229 neonates. Pediatr Surg Int. 2022; 38:1533-40.
Podevin G, Lardy H, Azzis O, et al. Technical problems and complications of a transanal pull-through for Hirschsprung’s disease. Eur J Pediatr Surg. 2006; 16:104–8.
Peyvasteh M, Askarpour S, Ostadian N, et al. Diagnostic accuracy of barium enema findings in Hirschsprung’s disease. Arq Bras Cir Dig. 2016; 29:155-8.
Ksia A, Yengui H, Ben Saad M, et al. Soave transanal one-stage endorectal pull-through in the treatment of Hirschsprung's disease of the child above two-year-old: A report of 20 cases. Afr J Pediatr Surg. 2013; 10: 362-6.
Tannuri AC, Tannuri U, Romao RL. Transanal endorectal pull-through in children with Hirschsprung's disease-technical refinements and comparison of results with the Duhamel procedure. J Pediatr Surg. 2009; 44: 767-72.
Westfal ML, Okiemy O, Chung PHY, et al. Optimal timing for Soave primary pull-through in short-segment Hirschsprung disease: A meta-analysis. J Pediatr Surg. 2022; 57:719-25.
Pratap A, Gupta DK, Shakya VC, et al. Analysis of problems, complications, avoidance and management with transanal pull-through for Hirschsprung disease. J Pediatr Surg. 2007; 42:1869–76.
Kamal Abd El-Elah Ali. Transanal endorectal pull-through for Hirschsprung's disease during the first month of life. Ann Pediatr Surg. 2010; 6:81-8.
Xie C, Yan J, Zhang Z, et al. Risk factors for Hirschsprung-associated enterocolitis following Soave: a retrospective study over a decade. BMC Pediatr. 2022; 22:654.
Roorda D, Oosterlaan J, van Heurn E, et al. Risk factors for enterocolitis in patients with Hirschsprung disease: A retrospective observational study. J Pediatr Surg. 2021; 56:1791-8.
Teitelbaum DH, Cilley RE, Sherman NJ, et al. A decade of experience with the primary pull-through for Hirschsprung disease in the newborn period: a multicenter analysis of outcomes. Ann Surg. 2000; 232:372–80.
Skarsgard D, Superina R, Shandling B, et al. Initial experience with one-stage endorectal pull-through procedures for Hirschsprung’s disease. Pediatr Surg Int. 1996; 11:480–2.
Tran VQ, Mahler T, Dassonville M, et al. Long-term outcomes and quality of life in patients after Soave pull-through operation for Hirschsprung’s disease: An observational retrospective study. Eur J Pediatr Surg. 2018; 28:445-54.

Published
How to Cite
Issue
Section
License
Copyright (c) 2023 Nahla Kechiche, Sahla Sellami, Dorsaf Makhlouf, Rachida Lamiri, Nahla Hmidi, Seifeddine Zayani, Amine Ksia, Lassaad Sahnoun, Mongi Mekki, Mohssen Belguith

This work is licensed under a Creative Commons Attribution 4.0 International License.
You are free to:
- Share — copy and redistribute the material in any medium or format
- Adapt — remix, transform, and build upon the material for any purpose, even commercially.
Terms:
- Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.
- No additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.