The Outcomes of The Minimally Invasive Trans-Anal Endorectal Pull-Through (TEPT) In the Management of Hirschsprung's Disease: A Retrospective Study
Abstract
https://doi.org/10.31386/dmj.2026.20.2.2
AbstractBackground: Hirschsprung's disease (HD) is a congenital neurodevelopmental disorder characterized by the absence of ganglion cells in the distal colon, leading to functional intestinal obstruction. The Trans-anal Endorectal Pull-Through (TEPT) has emerged as a minimally invasive surgical approach offering advantages over traditional open procedures. This study aims to present our institutional experience with TEPT in the management of HD, focusing on perioperative and long-term outcomes.
Patients and Methods: This retrospective study included 39 patients with HD who underwent a Soave-type TEPT at Duhok Pediatric Surgery Center between January 2016 and September 2024. Data on demographics, symptoms, surgical details, and post-operative outcomes were collected. All patients had a protective colostomy prior to the definitive pull-through.
Results: The cohort comprised 32 males and 7 females. Operation times ranged from 30 to 90 minutes with no intraoperative blood transfusions. A notable 34 out of 39 patients successfully underwent a single TEPT. Post-operative outcomes revealed favorable results in 30 (77%) patients, including 25 (64%) who achieved asymptomatic status with normal bowel function. Nine patients (23%) experienced complications, primarily persistent constipation (4 patients) and residual aganglionic segments (5 patients), the latter requiring further surgery. All redo cases achieved successful outcomes. The overall success rate for HD management in this cohort, including those requiring redo surgeries, was 87%.
Conclusion: The minimally invasive TEPT is a safe and effective surgical approach for pediatric Hirschsprung's Disease. The majority of patients achieve successful outcomes with good bowel function. Although complications can occur, they are largely manageable, with subsequent re-operations leading to successful functional results.
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Duhok Medical Journal (DMJ)
College of Medicine, University of Duhok
Duhok, Iraq
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