PULL-THROUGH PROCEDURE FOR HIRSCHSPRUNG'S DISEASE: TRANSANAL OR TRANSABDOMINAL? A COMPARATIVE STUDY.

Aim: To document our experience with the transanal pull-through procedure, to compare its results of with the results of the one-stage open Soave procedure and to compare results one-stage procedures with the gold standard multi-stage. 
Methods: The prospective part of the study included twenty-eight patients with biopsy-proven HD. The retrospective part of the study included 277 patients treated by Soave multistage procedure. Patients were randomized into; Group A: treated by the transanal pull-through procedure. Group B: treated by the trans-abdominal one-stage Soave pull-through procedure. 
Group C: treated by Soave multistage procedure. 
Results: The operative bleeding, the operating time, the onset of oral feeding, the postoperative pain, the hospital stay, the length of follow-up and costs were the only statistically significant variables. Functional results were good in 92.86%, 
85.71%, and 88.09% of patients of groups A, B and C respectively. Postoperative complications were seen mainly in groups C then B. For groups A and B, there had been no recurrence of obstructive symptoms. Hospital stay was significantly longer in the groups C and B. Cost was significantly higher in the group C than group B and group A. 
Conclusions: In selected cases, one stage pull-through operation can be safely done. Transanal technique is superior to open Soave due to its simplicity, cost effectiveness, and less surgical morbidity. It can be tolerated very well in the newborns. The operative technique can be easily mastered. It could be carried out in older children with little morbidity. Long-term followup will be required to determine whether early total reconstruction produces better lifelong bowel function than traditional staged repairs.