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
Pediatric Surgery International, cilt.42, sa.1, 2026 (SCI-Expanded, Scopus)
- Yayın Türü: Makale / Tam Makale
- Cilt numarası: 42 Sayı: 1
- Basım Tarihi: 2026
- Doi Numarası: 10.1007/s00383-026-06551-y
- Dergi Adı: Pediatric Surgery International
- Derginin Tarandığı İndeksler: Science Citation Index Expanded (SCI-EXPANDED), Scopus, CINAHL, EMBASE, MEDLINE, Academic Search Ultimate (EBSCO), Biomedical Reference Collection: Corporate Edition (EBSCO), Health Research Premium Collection (ProQuest)
- Anahtar Kelimeler: Hirschsprung disease, Transanal endorectal pull-through, Surgical outcomes, Long-term functional results, Surgical expertise, Follow-up
- Sağlık Bilimleri Üniversitesi Adresli: Evet
Özet
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.