Transanal endorectal pull-through in children as the treatment for Hirschsprung’sd in Aceh, Indonesia

Muntadhar M. Isa, Dian A. Syahputra, Muhammad Bayu Z. Hutagalung


Background: One-stage pull-through operation has become increasingly popular for the treatment of Hirschsprung's disease. The advantages of total transanal pull-through include minimal resection of the dilated ganglionic part of the colon, shorter hospital stay, decreased total cost, lower risk of adhesive intestinal obstruction.

Methods: A retrospective study of patients with HD underwent transanal endorectal pull-through (TERPT) procedure treated at Dr. Zainoel Abidin Hospital Banda Aceh, Indonesia between January 2010 – December 2013. We assessed patients characteristic, outcome and complication including Hirsch sprung associated enterocolitis (HAEC).

Results: A total 77 patients were included in this study. The mean age was 13.01 months (range from 11 days – 8 years old). Most of the patients (55.8%) were male and female (44.2%). Clinical classification of HD: short segment 74 patients (96.1%) and ultra-short segment 3 patients (3.9%). The mean of bowel resection length in TERPT procedure was 18.64 cm (range from 7–25 cm). There is no mortality associated with TERPT procedure. Hirsch sprung associated enterocolitis (HAEC) occurred in 43 subjects (54.5%). Statistical analysis showed the significant relation between age at surgery and HAEC (p= 0.000) and no significant relationship between gender (p=0.425) and bowel resection length (p=0.780) with HAEC.

Conclusions: Transanal endorectal pull-through procedure has been shown as an effective minimally invasive treatment in resolving obstructive symptoms in ultra–short segment of HD patients. The number of HAEC incidence among HD patients underwent TERPT significantly increased with older age of children.



Transanal endorectal pull-through, Hirschsprung’s disease, Treatment

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Murphy F, Puri P. New insights into the pathogenesis of Hirschsprung’s associated enterocolitis. Pediatr Surg Int. 2005;21(10):773–9.

Doodnath R, Puri P. A systematic review and meta-analysis of Hirschsprung’s disease presenting after childhood. Pediatr Surg Int. 2010;26(11):1107–10.

Stensrud KJ. Transanal endorectal pull-through for Hirschsprung Disease – Outcome in relation to surgical approach, age and anal canal morphology (Dissertation). University of Oslo, 2016

De la Torre-Mondragón L, Ortega-Salgado JA. Transanal endorectal pull-through for Hirschsprung’s disease. J Pediatr Surg. 1998;33(8):1283-6.

Pratap A, Chandra V, Kumar B, Sinha A, Tiwari A, Shekhar C, et al. Single-stage transanal endorectal pull-through for Hirschsprung’s disease: perspective from a developing country. J Pediatr Surg. 2007;42(3):532–5.

Hadidi BA. Transanal Endorectal Pull-Through for Hirschsprung’s Disease: Experience with 68 Patients. J Pediatr Surg. 2003;38(9):1337–40.

Ortiz-rubio I, Pérez-aguilera M, Granéli C, Stenström P, Arnbjörnsson E. Literature Review of the Outcome after One-Stage Transanal Endorectal Pull-Through Procedure for Hirschsprung’s Disease in Children. Surg Sci. 2013;3(4):258–62.

Lu C, Hou G, Liu C, Geng Q, Xu X, Zhang J, et al. Single-stage transanal endorectal pull-through procedure for correction of Hirschsprung disease in neonates and nonneonates: A multicenter study. J Pediatr Surg. 2017;52(7):1102-7.

Abdul-ghafoor BH, Abdullah AF, Al-amery MAF. Transanal Endorectal Pull-Through Procedure for patients with Hirschsprung`s Disease: A prospective study. J Fac Med Baghdad. 2015;57(4):269–72.

Pastor AC, Osman F, Teitelbaum DH, Caty MG, Langer JC. Development of a standardized definition for Hirschsprung’s associated enterocolitis: A Delphi analysis. J Pediatr Surg. 2009;44(1):251–6.

Frykman PK and Short SS. Hirschsprung-Associated Enterocolitis: Prevention and Therapy. Semin Pediatr Surg. 2013;21(4):328–35.

Haricharan RN, Seo J, Kelly DR, Mroczek-musulman EC, Aprahamian CJ, Morgan TL, et al. Older Age at Diagnosis Of Hirschsprung Disease Decreases Risk Of Postoperative Enterocolitis, But Resection Of Additional Ganglionated Bowel Does Not. J Pediatr Surg. 2008;43(6):1115.

Hackman DJ, Filler RM, Pearl RH. Enterocolitis After the Surgical Treatment Of Hirschsprung's Disease: Risk Factors And Financial Impact. J Pediatr Surg. 1998;33(6):830-3.