(A) comparison of one-stage transanal endorectal pull-through and Duhamel pull-through operations for Hirschsprung’s disease

Abstract

Purpose: This study aimed to compare the operative results of the one-stage transanal endorectal pull-through operation (TERPT) with those of the Duhamel pull-through operation (DPT) for Hirschsprung’s disease, including long-term functional outcomes. Methods: Clinical data and postoperative courses of Hirschsprung’s disease patients who had aganglionic bowel confined to the rectosigmoid and who underwent TERPT or DPT prior to 1 year of age between 2001 and 2013 at Severance Children’s Hospital were reviewed and analyzed. Results: Fifty-one patients underwent TERPT, and 50 patients underwent DPT. Age at the time of the pull-through operation is significantly younger in the TERPT group (1.7 ± 1.9 vs. 4.0 ± 2.4 months, p<0.001), and the mean operation time of TERPT was significantly shorter than that of DPT (154.6 ± 52.4 vs. 196.6 ± 65.0 min, p=0.001). Operation-related complications among those in the TERPT group were significantly fewer than among those in the DPT group (0 vs. 18%, p=0.001). However, hospital stays following the operation did not significantly differ (9.6 ± 3.1 vs. 11.4 ± 9.3 days, p=0.200). The readmission rate was also significantly lower in the TERPT group (39.2 vs. 64.0%, p=0.013). With respect to the long-term functional outcome, the TERPT group had a significantly lower incidence of soiling (4.3 vs. 43.2%, p<0.001) and constipation (2.1 vs. 16.2%, p=0.040). Conclusion: This study results showed significantly better postoperative clinical outcomes in the TERPT group. These results support the superiority of the TERPT procedure over DPT.