Long-term bowel functional outcomes after surgery for Hirschsprung disease: a comparative study of Duhamel and transanal endorectal pull-through.

PURPOSE: Long-term bowel dysfunction remains a major concern after surgery for Hirschsprung disease (HD). This study aimed to compare age-dependent bowel functional outcomes between the Duhamel procedure and transanal endorectal pull-through (TAEPT) up to 15 years.

METHODS

This retrospective single-center study included 101 patients who underwent surgery for HD between 1978 and 2025. Seventy-one patients underwent the Duhamel procedure, and 30 underwent TAEPT. Postoperative bowel function was assessed using a standardized bowel function score (BFS; maximum: 8), evaluating urge to defecate, constipation, incontinence, and soiling at 5, 7, 10, and 15 years.

RESULTS

Bowel function improved with age in both groups and plateaued by adolescence. The Duhamel group had significantly higher BFS than the TAEPT group at 5, 7, and 10 years (all P < 0.05). Domain-specific analysis exhibited improved urge to defecate at 5 and 7 years and better incontinence and soiling scores at 10 years in the Duhamel group. No significant differences were observed at 15 years.

CONCLUSION

The Duhamel group had higher bowel function scores during childhood than the TAEPT group. However, these differences diminished with age, suggesting functional maturation. Understanding procedure-specific functional characteristics may contribute to individualized bowel management and improved long-term quality of life in HD.