Comparison of Early and Long-Term Outcomes Between LA-TEPT and TEPT in Left-Sided Hirschsprung Disease: Identification of Risk Factors for Postoperative Stricture, Enterocolitis, and Redo Surgery

M ökten¹, E Basuguy¹, S Arslan¹, M Azizoğlu², B Aydoğdu³, MH Okur³, MK Çiğdem¹

¹Dicle University, Department of Pediatric Surgery, Diyarbakır, Turkey
²Esenyurt Necmi Kadioglu State Hospital, Dep of Pediatric Surgery, Istinye University, Dep of Stem Cell and Tissue Engineering & 3D Bioprinting, Istanbul, Turkey
³Department of Pediatric Surgery, Faculty of Medicine Balıkesir Üniversity, Balıkesir, Turkey

Purpose:This study aimed to compare early and long-term outcomes of Laparoscopy-assisted transanal endorectal pull-through (LA-TEPT) and TEPT in left-sided Hirschsprung disease (HD) and identify risk factors for postoperative stricture, postoperative enterocolitis, and redo surgery.

Method:Between January 2010 and September 2024, a total of 151 patients with HD underwent surgery at our clinic. Patients who underwent LA-TEPT or TEPT for left-sided colonic HD were included. Early and long-term outcomes were evaluated.

Results:A total of 75 patients (LA-TEPT:36, TEPT:39) were included. No statistically significant differences were observed between the LA-TEPT and TEPT groups in terms of the following complications: constipation (LA-TEPT:n:14, 38.9%; TEPT:n:14, 35.9%; p:0.789), encopresis (LA-TEPT:n:10, 27.8%; TEPT:n:15, 38.5%; p:0.327), growth retardation (LA-TEPT:n:9, 25%; TEPT:n:7, 17.9%; p:0.456), stricture (LA-TEPT:n:12, 33.3%; TEPT:n:7, 17.9%; p:0.126), dermatitis (LA-TEPT:n:5, 13.9%; TEPT:n:2, 5.1%; p:0.193), enterocolitis (LA-TEPT:n:3, 8.3%; TEPT:n:4, 10.3%; p:0.775), soiling (LA-TEPT:n:4, 11.1%; TEPT:n:6, 15.4%; p:0.586), distension (LA-TEPT:n:2, 5.6%; TEPT:n:2, 5.1%; p:0.978), and the need for redo surgery (LA-TEPT:n:4, 11.1%; TEPT:n:3, 7.7%; p:0.611). In left-sided HD, postoperative stricture (OR:24.5, p:0.032) and growth retardation (OR:18.9, p:0.023) were significant predictors of redo surgery. Postoperative distension (OR:12.8, p:0.021) was significant in univariate but not in multivariate analysis (OR:11.43, p:0.105). Three-stage surgery (OR:3.636, p:0.042) was an independent risk factor; ileus (OR:3.9, p:0.060) showed a borderline association for postoperative stricture formation. Univariate analysis identified ileus (OR:15.6, p:0.004) and three-stage surgery (OR:6.4, p:0.027) as significant risk factors for postoperative enterocolitis.

Conclusions:LA-TEPT and TEPT showed comparable outcomes in left-sided HD. Postoperative stricture, growth retardation, ileus, and three-stage surgery were significant predictors of enterocolitis and need for redo surgery.

Keywords: LA-TEPT ,TEPT,Left Colon Hirschsprung

M ökten¹, E Basuguy¹, S Arslan¹, M Azizoğlu², B Aydoğdu³, MH Okur³, MK Çiğdem¹

¹Dicle University, Department of Pediatric Surgery, Diyarbakır, Turkey
²Esenyurt Necmi Kadioglu State Hospital, Dep of Pediatric Surgery, Istinye University Dep of Stem Cell, and Tissue Engineering & 3D Bioprinting, Istanbul, Turkey
³Balıkesir Üniversitesi Çocuk Cerrahisi ABD

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