Surgical outcomes for patients with rectosigmoid Hirschsprung disease after 1 year of age following transanal endorectal pull-through

Purpose: This study aimed to compare the differences in postoperative complications and long-term bowel function outcomes between patients with rectosigmoid Hirschsprung disease (HD) who underwent transanal endorectal pull-through (TEPT) beyond infancy (age＞ 1 year of age) and those during infancy (≤ 1 year of age). Methods: : All patients with rectosigmoid HD at Beijing Children’s Hospital between January 2011 and December 2020 were eligible. They were divided into two groups based on age at TEPT: group A was defined as patients who performed TEPT beyond infancy (age＞1 year of age), and group B as patients who performed TEPT during infancy (age≤ 1 year of age). Clinical details were collected from medical records. Bowel function outcomes were assessed by the Rintala questionnaire (age≥4 years). Results: : A total of 339 patients were included: 216 (63.7%) who operated with TEPT beyond infancy and 123 (36.3%) during infancy (group B). Regarding postoperative complications, all patients sufferinga anastomosis leakage following TEPT (7/216, 3.2%) occurred in group A and the rate of anastomosis leakage in group A was significantly higher than in group B (3.2% vs 0.0%, p=0.044). 228 patients (228/327, 69.7%) completed the Rintala questionnaire. There was no significant difference in long-term bowel function outcomes between the two groups. Conclusion: Compared with patients who performed TEPT during infancy, those beyond infancy are more likely to suffer anastomosis leakage, but long-term bowel function outcomes are comparable. TEPT should be performed during infancy for HD patients. Type of Study: A retrospective single-center study Level of evidence: Ⅲ