Swenson-like full-thickness versus endorectal pull-through procedures for rectosigmoid Hirschsprung disease: Ten-year experiences from a tertiary center in China and mid-term functional outcomes

The Swenson-like full-thickness pull-through procedure has been successfully adopted to treat Hirschsprung disease (HSCR). However, extensive studies on the postoperative bowel and urinary function after this procedure are limited. This study shares our experience and compares the functional outcomes with the endorectal pull-through procedure. We retrospectively analyzed 311 children with rectosigmoid HSCR from January 2010 to December 2020. Medical and follow-up data were reviewed. Bowel function was assessed using the Bowel Function Score (BFS), and lower urinary tract symptoms (LUTS) were recorded. Of the 311 patients, 60 underwent laparoscopic Swenson-like pull-through (LSwPT), 61 underwent laparoscopic endorectal pull-through (LERPT), 93 underwent total transanal Swenson-like pull-through (TSwPT), and 97 underwent total transanal endorectal pull-through (TERPT). Clinical characteristics and early postoperative complications were similar between the Swenson-like and endorectal groups, but the Swenson-like procedures had significantly shorter operative time. No significant differences were found in postoperative obstructive symptoms, constipation, or soiling issues between the Swenson-like and endorectal groups. The TSwPT group had a significantly lower rate of postoperative HAEC than the TERPT group, but this was not the case for the LSwPT and LERPT groups. Patients in the Swenson-like groups experienced fewer annual HAEC episodes than those in the endorectal groups. The results from BFS showed no statistical difference between these groups. The overall LUTS profiles were comparable for all symptoms. The Swenson-like full-thickness pull-through technique is safe and feasible. Compared with the endorectal pull-through procedure, it shortens the operative time and might have advantages in preventing postoperative HAEC. III.