Long-term outcomes of transanal endorectal pull-through for Hirschsprung disease: the role of a dedicated surgical team and structured follow-up in a 17-year cohort.

INTRODUCTION

The transanal endorectal pull-through (TEPT) procedure has become the preferred technique for Hirschsprung disease (HD). Long-term functional outcomes beyond five years remain underreported, particularly from Middle Eastern centers. This study evaluated surgical and long-term functional outcomes of TEPT at a single tertiary center over 17 years, with emphasis on surgical expertise and structured follow-up.

MATERIALS AND

METHODS

Patients with HD who underwent TEPT between January 2005 and December 2021 were retrospectively reviewed. More than 90% of procedures were performed and followed up by the same surgical team, consisting of pediatric surgeons specializing in colorectal surgery. Short-term outcomes and long-term functional outcomes including enterocolitis, anal stricture, constipation, and soiling were analyzed.

RESULTS

Ninety-one patients underwent TEPT; 75 (82.4%) were male. Median age at surgery was 5.3 months (range: 1.1-137 months). Short-segment disease was present in 77 patients (84.6%) and long-segment disease in 14 (15.4%). Single-stage TEPT was performed in 61 patients (67%). No perioperative complications occurred. Median hospital stay was 4.7 days. At a mean follow-up of 5.57 ± 3.74 years, enterocolitis occurred in 7 patients (7.7%), anal stricture in 16 (17.6%), constipation in 16 (17.6%), and soiling in 12 (13.2%), all of which resolved with conservative management except persistent soiling in 3 patients (3.3%). Long-segment disease showed numerically higher complication rates without reaching statistical significance.

CONCLUSION

In this cohort, TEPT was associated with no perioperative complications and a 7.7% enterocolitis rate markedly lower than many published series. The principal long-term functional complications were largely transient and resolved with conservative management. These outcomes were achieved with a standardized operative technique and a structured, surgeon-led follow-up protocol enabling early detection and treatment of complications. These findings suggest that HD care may be best concentrated in experienced, specialized pediatric surgical centers.