Safety and feasibility of one-stage neonatal approach for short-segment Hirschsprung’s disease

TL;DR

This study compares three surgical techniques for treating Hirschsprung’s disease in newborns, finding they are all safe and effective with similar long-term outcomes.

Contribution

The study provides comparative data on minimally invasive surgical approaches for neonatal Hirschsprung’s disease with short-segment involvement.

Findings

All three techniques (SILEP, CLEP, TERPT) had comparable long-term bowel function and low major complication rates.

SILEP and TERPT had shorter operative times compared to CLEP.

SILEP showed a trend toward better cosmetic outcomes than CLEP.

Abstract

Early definitive surgery for Hirschsprung disease (HD) in neonates is increasingly adopted to reduce preoperative morbidity and preserve long term bowel function. However, comparative data across minimally invasive approaches in neonates with short segment disease remain limited. This study compared outcomes of single incision laparoscopic assisted endorectal pull through (SILEP), conventional laparoscopic assisted endorectal pull through (CLEP), and complete transanal endorectal pull through (TERPT) for rectosigmoid HD.

We conducted a retrospective cohort study of 55 neonates who underwent one stage definitive surgery before 28 days of age at a high volume center between January 2019 and December 2021. The primary outcome was long term bowel function assessed using the Rintala Bowel Function Score (BFS) after a minimum of 4 years of follow up. Secondary outcomes included operative parameters, postoperative complications (Clavien Dindo classification), and cosmetic outcomes using the Manchester Scar Scale (MSS) in the laparoscopic groups.

All patients successfully underwent surgery at a mean age of 22.4 ± 4.3 days. Operative time differed across approaches and was shorter for SILEP (53.8 ± 11.9 minutes) and TERPT (52.1 ± 18.3 minutes) than for CLEP (70.2 ± 22.5 minutes, p = 0.036). At follow up (mean 54.0 ± 7.7 months), the overall BFS was 17.5 ± 2.5 with no significant differences among groups (p = 0.32). MSS was numerically lower for SILEP than for CLEP (6.2 ± 1.1 vs 6.8 ± 1.9, p = 0.53). Complications were infrequent, with 14 minor and 7 major events, and there was no mortality or Clavien Dindo grade IV or V morbidity.

SILEP, CLEP, and TERPT are feasible one stage options for neonates with rectosigmoid HD, with comparable long term bowel function and low rates of major complications. SILEP and TERPT were associated with shorter operative times, and SILEP showed a trend toward improved cosmetic scores compared with CLEP. These findings support an individualized approach to technique selection based on intraoperative requirements and institutional expertise.

Figures