Technical problems and complications of a transanal pull-through for Hirschsprung's disease

Eur J Pediatr Surg. 2006 Apr;16(2):104-8. doi: 10.1055/s-2006-923995.


Background: The purpose of this study was to evaluate the technical difficulties and complications of a transanal pull-through for Hirschsprung's disease.

Material and methods: This report was based on a multicentric retrospective study of 65 cases. Pull-through procedures were transanal Swenson or Soave procedures in 26 and 39 cases, respectively.

Results: Evaluation of the aganglionic level, peri-rectal dissection, and anastomosis were the three steps in the procedure where surgeons encountered difficulties. Such difficulties led to serious complications in 3 cases. A patient with a colon biopsy before the pull-through procedure had a postoperative pneumoperitoneum requiring a second laparoscopy for suture and washing. Another patient had peritonitis due to anastomotic leakage. Finally, a difficult rectal dissection in a neonate led to a urethral injury requiring secondary urethral repair. Only 41 of the 65 patients had no abdominal scars (63 %).

Conclusion: We considered the transanal pull-through for Hirschsprung's disease to be a reliable technique. Nevertheless, it requires an urethral stent, precise dissection, careful anastomosis and selected indications in order to avoid major complications.

Publication types

  • Multicenter Study

MeSH terms

  • Anastomosis, Surgical / adverse effects
  • Child
  • Child, Preschool
  • Cicatrix
  • Digestive System Surgical Procedures / adverse effects*
  • Female
  • Hirschsprung Disease / surgery*
  • Humans
  • Infant
  • Infant, Newborn
  • Intestinal Obstruction / etiology
  • Intraoperative Complications*
  • Male
  • Peritonitis / etiology
  • Pneumoperitoneum / etiology
  • Postoperative Complications*
  • Reoperation
  • Retrospective Studies
  • Urethra / injuries