Transanal Endorectal Pull-Through in Children with Hirschsprung Disease: 15 Years of Single-Center Experience

BACKGROUND: Hirschsprung disease is one of the most complex and severe congenital malformations. The choice of surgical treatment depends on the wide spectrum of disease forms and clinical manifestations. Currently, the transanal endorectal pull-through technique is considered the most promising surgical approach. The greatest challenge is the management of complications such as Hirschsprung-associated enterocolitis and coloanal anastomotic stricture. The implementation of new surgical techniques allows for a reduction in postoperative complications and improvement in treatment outcomes in patients with Hirschsprung disease.

AIM: The study aimed to improve surgical outcomes in patients with Hirschsprung disease based on the analysis of results of transanal endorectal pull-through procedures using the authors’ modification and preventive management of potential complications.

METHODS: An analysis was conducted of surgical treatment of Hirschsprung disease using the transanal endorectal pull-through technique between 2010 and 2024. Since 2015, a modified technique has been used during pull-through surgery: resection of the muscular cuff along the posterior wall of the anal canal following endorectal dissection of the rectum in the submucosal layer. Required morphological and radiological evaluations were carried out. The obtained data were statistically analyzed using the Statistica software package (Version 10-Index, StatSoft Inc.).

RESULTS: Over the past 15 years, 2010–2024, 112 patients under 3 years of age with Hirschsprung disease underwent transanal endorectal pull-through at the Republican Scientific and Practical Center for Pediatric Surgery. A reduction in the incidence of anastomotic strictures was achieved following the introduction of posterior muscular cuff resection during transanal endorectal pull-through (in 2015): from 23.7% (9 out of 38 patients) in 2010–2014 to 8.3% (4 out of 48 patients) in 2015–2019, and further to 3.6% (1 out of 26 patients) in 2020–2024. The incidence of enterocolitis also gradually declined, from 25% (21 of 86 patients) in 2010–2019 to 14.3% (4 of 26 patients) in 2020–2024. It was found that the use of transanal endorectal pull-through with resection of the muscular cuff led to a reduction in postoperative complications.

CONCLUSION: Transanal endorectal pull-through with resection of the posterior muscular cuff in children with Hirschsprung disease, along with preventive management of potential complications, can be considered the optimal technique of surgical treatment for this condition.