Outcome of Primary Transanal pull through for Short segment Hirschsprung's disease in children without frozen section

Abstract

BackgroundHirschsprung's disease is a congenital disorder of the enteric nervous system. There are many type of pull through surgeries (e.g.) Duhamel, Soave, Swenson etc. and are done openly as well as laparoscopically. This can be performed in multiple stages or in a single stage (primary). MethodologyThis cross sectional study was conducted at Pediatric Surgery Department, Lady Reading Hospital, Peshawar from January 2022 till December 2022, after approval from ethical committee (IRB # 489/LRH/MTI). All Children up to 16 year age presented with short segment Hirschsprung's disease on contrast enema and with confirmed absence of ganglion cells on rectal biopsy were included in the study. Patients with syndromic Hirschsprung's disease, those with stoma, previous surgery, not responding/compliant to rectal washout and parents unwilling for the procedure were excluded. All patient underwent Primary Transanal Pull Through (PTAPT) without frozen section. All patients were followed up to 6 months post-op. ResultsOut of 88 patients, 18(20.4%) had complications. Anastomotic stricture was found to be the most common. Complications were found to be more in male patients who were less than 6 months old. None of the patient had aganglionic or transitional zone pull through. ConclusionPTAPT can be done safely in Short segment Hirschsprung's disease in centers without frozen section facility with comparable results. At least 5 cm resection should be done proximal to the transition zone to avoid aganglionic bowel or transition zone pull through. The incidence of complications is more in males and in patients aged less than 6 months. Level of evidenceLevel IV