Endorectal pull-through for Hirschsprung's disease-a multicenter, long-term comparison of results: transanal vs transabdominal approach

Anne C. Kim, Jacob C. Langer, Aimee C. Pastor, Lingling Zhang, Cornelius E.J. Sloots, Nicholas A. Hamilton, Matthew D. Neal, Brian T. Craig, Erin K. Tkach, David J. Hackam, Nicolaas M.A. Bax, Patrick A. Dillon, Jennifer N. Chamberlain, Daniel H. Teitelbaum

Research output: Contribution to journalArticlepeer-review

68 Scopus citations


Purpose: Previous studies have reported decreased continence in patients undergoing transanal endorectal pull-through (TERP) for Hirschsprung's disease compared to the older transabdominal approach (TAA). To address this, we examined long-term stooling outcomes in a large, multicenter cohort of patients undergoing either TERP or TAA. Methods: Data were collected from 5 large pediatric institutions. Patient families were surveyed using a stooling score system (0-40, best to worst total score). Inclusion criteria included patients older than 3 years and those who had more than 6 months of recovery after pull-through. Those with total colonic aganglionosis were excluded. Statistical analysis included univariate and multivariate linear regression (significance, P < .05). Results: Two hundred eighty-one patients underwent TERP (192) or TAA (89). Interviews were completed in 149 (104 [52%] TERP vs 45 [52%] TAA). The TAA group had a significantly greater number of daily bowel movements for each respective postoperative year and experienced more early complications (3% vs 1% with >1 complication; P = .061) and late complications (19% vs 4% with >1 complication; P < .001). Although the TAA group had a higher mean enterocolitis score (3.3 ± 0.4 vs 1.8 ± 0.2; P < .001), this was not borne out by multivariate regression analysis (P = .276). Parental survey showed that there were no significant differences between procedures in mean total, continence, or stooling pattern scores. Conclusion: Transanal endorectal pull-through was associated with fewer complications and fewer episodes of enterocolitis. In contrast to prior studies, TERP patients did not have a higher rate of incontinence. These results support use of TERP as an excellent surgical approach for children with Hirschsprung's disease.

Original languageEnglish (US)
Pages (from-to)1213-1220
Number of pages8
JournalJournal of pediatric surgery
Issue number6
StatePublished - Jun 2010
Externally publishedYes


  • Continence
  • Enterocolitis
  • Hirschsprung's disease
  • Pull-through
  • Stooling

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Surgery


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