WOFAPS 2025 8th World Congress of Pediatric Surgery

. Gunadi, Qisthinadia Hazhiyah Setiadi, Rizka Annisa Harahap, Pramana Adhityo, Nova Yuli Prasetyo Budi, Achmad Reza Kurniawan, Dutha Patria Huthama, Jennifer Maharina Rizky, Henggar Allest Pratama, Krisna Dwiantama

Gadjah Mada University

Background: Transanal Swenson-like pull-through is one of the most common procedures for treating Hirschsprung disease (HSCR), involving careful dissection of the full thickness of the rectal wall. Surgeons must have the necessary experience and technical skills to prevent accidental injury to the organs located anterior to the rectum, including vagina, urethra, and bladder, which could lead to long-term complications. In addition, previous studies have documented cases of unintentional injuries to these organs, including urethral and vaginal injuries, following the transanal Swenson-like pull-through.

Methods: We conducted a retrospective study involving patients with HSCR who underwent transanal Swenson-like pull-through at our institution from 2020 to 2025. We reviewed data collected from patient medical records, including sex, type of aganglionosis, age at the time of definitive surgery, functional outcomes, intraoperative complications, and postoperative results. We compared outcomes, including voluntary bowel movements (VBM), soiling, and constipation, among patients who underwent either a standard or modified transanal Swenson-like pull-through.

Results: A total of 64 patients participated in this study. Of these, 46 patients underwent the standard Swenson-like pull-through, with one patient experiencing an intraoperative complication, i.e., urethral injury. In contrast, 18 patients underwent the modified transanal Swenson-like pull-through, with two of them being redo pull-throughs. These patients had initially undergone a traditional transanal Swenson-like pull-through and a Duhamel pull-through, respectively. No injuries to the anterior organs, such as urethra, vagina, or bladder, occurred with the modified technique. Furthermore, patients who underwent both the standard and modified transanal Swenson-like pull-through procedures reported satisfactory outcomes during postoperative follow-up, including VBM, reduced soiling, and the absence of constipation.

Conclusion: Modified transanal Swenson-like pull-through for HSCR is both safe and effective, particularly in preventing iatrogenic injuries to anterior organs during dissection, even in cases of redo pull-through. Overall, functional outcomes for HSCR patients following transanal Swenson-like pull-through were favorable.