Modified Duhamel pull-through vs. Trans-anal endorectal pull-through in children with Hirschsprung's disease: Outcome comparison from a single center over 14 years

Purpose: To analyze and compare short-term results and long-term bowel function in patients with Hirschsprung disease (HD) following two commonly performed definitive surgeries at our institute: Modified Duhamel pull-through (MDPT) and transanal endorectal pull-through (TERP). Methods: 103 cases of HSD who underwent pull-through procedures (MDPT, n = 71; TERP, n = 32) between 2007 and 2021 were included. Seventy-nine were assessed for bowel function by Rintala scoring (MDPT, n = 53; TERP, n = 26). Results: The MDPT group had more early complications (40.84% MDPT vs. 25% TERP), including anastomotic leak (4.2%, n = 71) and adhesive intestinal obstruction (5.6%, n = 71). Rectal mucosal prolapse (3.1%, n = 32) and anal stricture (3.1%, n = 32) were noted exclusively following the TERP. Both groups had a similar incidence of HAEC (21% in MDPT vs. 20% in TERP). TERP group had more daily bowel movements post-pull-through (71.8% vs. 22.5% in MDPT). Bowel function was considered impaired, with Rintala score of < 17 in 61.5% of cases of TERP (vs. 16.9% of cases of MDPT, n = 53; P = 0.001). Conclusion: In our institute, we found better bowel function outcomes following MDPT compared to TERP, with higher incidence of soiling and accidents following TERP. However, long-term outcomes following technical changes in performing the TERP procedure remains to be assessed.