Transanal Endorectal Pull-Through (TERPT) Versus Laparoscopic-TERPT for The Treatment of Hirschsprung’s Disease: A Comparatives Study of Outcome

Abstract

Background: Hirschsprung’s disease (HD) is a congenital disorder resulting from the absence of ganglion cells in the distal colon, necessitating surgical treatment. This study compares two minimally invasive surgical techniques: Transanal Endorectal Pull-Through (TERPT) and Laparoscopic-TERPT (LERPT). Objective: The objective of this study was to evaluate and compare the surgical outcomes of TERPT and LERPT in children with Hirschsprung’s disease, aged 4 to 13 years, to determine the more effective procedure. Methods: A total of 53 pediatric patients who underwent either TERPT (n=26) or LERPT (n=27) between January 2022 and June 2023 at Rajshahi Medical College Hospital were analyzed. Data collected included operative time, hospital stay, complications, and long-term outcomes. Statistical analysis was conducted using p-values, standard deviation, and outcome percentages. Results: The median operative time was 158 minutes (SD=24.7, range: 84–198) for TERPT and 176 minutes (SD=29.1, range: 95–218) for LERPT, with a significant difference (p=0.016). The median hospital stay was 7.81 days (SD=2.3) for TERPT and 4.35 days (SD=1.2) for LERPT (p=0.031). Infection occurred in 26.92% (7/26) of TERPT patients compared to 7.41% (2/27) of LERPT patients (p=0.038). Postoperative ileus was present in 23.08% (6/26) of TERPT patients compared to 7.41% (2/27) in LERPT (p=0.056). Anastomotic stricture rates were 30.76% (8/26) in TERPT and 14.81% (4/27) in LERPT (p=0.048). Persistent obstructive symptoms occurred in 19.23% (5/26) of TERPT and 7.41% (2/27) of LERPT patients (p=0.043). Conclusion: LERPT demonstrated better outcomes in terms of operative time, complications, and recovery, suggesting it as the preferred approach for pediatric Hirschsprung’s disease.