Document Type : original article
Authors
1
Department of Surgery, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
2
Department of Pediatric Surgery, Akbar Children’s Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
3
Department of Pediatric Surgery, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
4
Student Research Committee, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
5
Department of Pediatric Surgery, Mashhad University of Medical Sciences, Mashhad, Iran
10.22038/jpp.2026.98299.5723
Abstract
Background: Transanal endorectal pull-through (TERPT) is frequently utilized for the management of Hirschsprung’s disease (HD) due to its minimal invasiveness. This study aimed to compare postoperative complications and outcomes between pediatric HD patients undergoing TERPT and those treated with the transabdominal pull-through (TAB) approach.
Methods: A multicenter, retrospective observational cohort study was performed on 241 children diagnosed with HD (n = 135 TERPT; n = 106 TAB) treated at two tertiary pediatric surgical centers from 2014 to 2018. Patients were categorized by surgical technique. Postoperative complications and long-term outcomes were compared using chi-square or Fisher’s exact tests, as appropriate. Mortality was recorded and compared between groups.
Results: Perianal dermatitis was more frequent in the TERPT group (22.2% vs. 6.6%; P = 0.001). In contrast, infection (0.7% vs. 9.4%; P = 0.001), anastomotic leak (0.7% vs. 7.5%; P = 0.012), constipation (9.6% vs. 18.9%; P = 0.038), and abdominal scarring (2.2% vs. 20.8%; P < 0.001) were significantly more frequent in the TAB group. Wound dehiscence, ileus, enterocolitis, anastomotic stricture, adhesive obstruction, and incontinence did not differ significantly between groups. Overall mortality was 8.7% (11/135 TERPT vs. 10/106 TAB; P = 0.72).
Conclusion: In this retrospective cohort, TERPT was associated with fewer observed wound-related and abdominal complications compared with TAB. However, these findings should be interpreted cautiously given the observational, non-randomized design, which limits causal inference regarding superiority of either technique
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