24-month outcomes of primary transanal swenson pull-through for treatment of Hirschsprung disease in children

Background Hirschsprung disease (HD) lacks ganglion cells in the distal intestine. Transanal pull-through treats selected rectosigmoid disease. Aim To evaluate 24-month outcomes of full-thickness transanal Swenson pull-through in neonates with rectosigmoid HD, focusing on complications, bowel-function, HAEC, and soiling. Patients and methods This prospective, single-center, non-comparative observational study included 50 selectively recruited neonates with biopsy-proven rectosigmoid HD treated by transanal Swenson pull-through at Cairo University Specialized Pediatric Hospital. Long-segment disease, previous pull-through or stoma, and active enterocolitis or sepsis were excluded. Soiling was recorded as a descriptive finding; fecal continence was not assessed because voluntary bowel control is not established at this age. Results Thirty-six patients (72%) were male. Mean age at surgery was 19.8 ± 2.8 days, excluding two patients operated on at approximately 45 days after preoperative HAEC treatment. Mean bowel resection length was 16.7 ± 3.2 cm; 9 patients (18%) required postoperative blood transfusion. Mean hospital stay was 4.1 ± 0.9 days. Postoperative constipation occurred in 7 (14%), HAEC in 6 (12%), anastomotic stricture in 5 (10%), and early soiling in 41 (82%). Eight patients (16%) required readmission; overall complications occurred in 20%. No persistent constipation was documented at 24 months. Continence was unassessable because children had not reached toilet-training age. Conclusion Primary transanal Swenson pull-through provided favorable recovery and 24-month outcomes in selected HD-neonates. The non-comparative design, selective recruitment, small sample, and limited follow-up preclude conclusions about superiority over other techniques. Larger comparative studies with adolescent follow-up are needed to assess long-term function, particularly fecal continence.