Primary pull-through for Hirschsprung's disease: abdominal vs transanal

ABSTRACT

In the last few years, one stage pull-through operation for Hirschsprung's disease has replaced the previous gold standard of 2 or 3-stage procedures. One stage procedure can be done abdominally, by laparoscope, or completely trans-anally. In this research, we compared trans-anal with abdominal approach for one-stage pull-through for Hirschsprung's disease. The study was done in Zagazig University Hospitals and included 24 patients with biopsy proven Hirschsprung's disease. The patients were selected according to standard inclusion and exclusion criteria, and were prospectively randomized into group A with trans-anal and group B with abdominal approach. Assessment included patients data, operative and early post-operative courses. Also, late operative sequelae [within 6 months] were evaluated according to unified system. There was significant increase in operative blood loss and hospital stay in-group B. No significant difference was evident between the two approaches concerning early and late postoperative sequelae. Avoidance of laparotomy in trans-anal route is attractive, but more studies are needed to confirm its safety and to stratify indications and contraindications of its use