Early functional outcomes of the Swenson ileoanal pull-through for total colonic Hirschsprung disease at a high-volume referral center.

[INTRODUCTION] There is no consensus for the optimal surgical approach for total colonic Hirschsprung disease (TCHD) and few studies report functional outcomes for the ileoanal Swenson pull-through (IAPT).

[METHODS] A single-center retrospective review identified patients with TCHD who underwent IAPT between 1/2020 and12/2023. Complications and functional outcomes were reviewed descriptively.

[RESULTS] 25 patients (64 % male) underwent IAPT at a median age of 1.6 years (range 0.6, - 15.6; IQR, 0.9-7.0) with a median follow-up of 16 months (range, 1-39; IQR, 3-26). Four patients required readmission within 30 days and 8 within 1 year. One patient required readmission for Hirschsprung's associated enterocolitis (HAEC) within 30 days and Four within 1 year. One patient had an unplanned return to the operating room. At 1 month, 48 % (12/25) reported ≥14 stools/day and 20 % (5/25) had 1-7 stools/day. Among patients with at least 1 year follow up only 14 % (2/14) reported ≥14 stools/day and 57 % (8/14) reported 1-7 stools/day. At 1 month, 48 % (12/25) reported severe or active perianal excoriation; by 1 year, no patients reported severe or active perianal excoriation. One patient underwent elective ileostomy creation due to a high stooling frequency. Overall, 64 % (16/25) underwent anal botulinum toxin injection for withholding, 16 % (4/25) required treatment for small intestinal bacterial overgrowth, and 12 % (3/25) required treatment for proctalgia fugax.

[CONCLUSION] Patients with TCHD who undergo IAPT have low perioperative complication rates, and most achieve manageable stooling patterns without severe or active perianal excoriations by at least 1 year after IAPT. Approximately two-thirds of patients may require botulinum toxin treatment for non-relaxing sphincters.

[IRB APPROVAL] STUDY00000962.

[STUDY TYPE] Single institution.

[LEVEL OF EVIDENCE] IV.