Hirschsprung disease (HD) is a rare congenital disorder of the enteric nervous system, affecting approximately 1 in 5,000 live births. It is characterized by the absence of ganglion cells in the distal colon, leading to functional intestinal obstruction due to impaired peristalsis. Surgical treatment consists of resection of the aganglionic segment-most commonly rectosigmoid-followed by a colo-rectal, colo-anal, or ileo-anal anastomosis.
Among colo-anal pull-through procedures, the Swenson technique was historically performed through an exclusively transanal approach, which carries a risk of sphincter injury correlated with operative duration. More recently, combined laparoscopic and transanal approaches have been developed to reduce this risk, although they may be associated with higher overall complication and reoperation rates.
The Swenson procedure can be performed using a single-port laparoscopic approach, a technique that is sparsely described in the literature and rarely practiced in France. Single-port laparoscopy represents an emerging surgical technique that, despite increased technical complexity for surgeons, may further enhance postoperative recovery and cosmetic outcomes compared to conventional multiport laparoscopy.
The objective of this study is to describe the outcomes of single-port laparoscopic Swenson pull-through in children with Hirschsprung disease and to compare them with outcomes obtained using more conventional approaches, namely exclusive transanal surgery or combined multiport laparoscopic and transanal approaches.
Children under 16 years of age
Diagnosis of Hirschsprung disease confirmed by initial rectal biopsy and postoperative pathological examination
Primary Swenson coloanal pull-through performed at Angers or Caen University Hospital between January 1, 2010 and June 30, 2025
Parental or legal guardian opposition to the use of medical data for research purposes
Hirschsprung disease treated with other surgical techniques (Duhamel, Soave, De La Torre, TERPT)
Patients operated on in another hospital
Patients who underwent rectosigmoid resection for causes of constipation other than Hirschsprung disease
Children under 16 years of age with diagnosis of Hirschsprung disease confirmed by initial rectal biopsy and postoperative pathological examination
Cohort
Retrospective
transanal or laparoscopy assisted Swenson coloanal pullthrough
Procedure/SurgeryTA-Swenson consist of total trananal endorectal pullthrough after a short submucosal dissection of the last part of the rectum. Laparoscopy-assisted Swenson pull-through consists of laparoscopic mobilization of the aganglionic colon with intraoperative level confirmation, followed by a transanal resection of the aganglionic segment and a primary coloanal anastomosis
To compare the short-term effectiveness of different surgical laparoscopic approaches used for the Swenson technique.
Short-term effectiveness, defined as spontaneous bowel transit without obstructive-spectrum events during the first postoperative year, including: * Constipation * Delayed resumption of oral feeding * Sphincter hypertonicity * Hirschsprung-associated enterocolitis
To compare intraoperativensurgical efficiency according to surgical approach
Surgical efficiency, defined as operative time for coloanal anastomosis completion without conversion, including the approach for intraoperative frozen-section biopsy.
To compare immediate postoperative recovery
Recovery, defined as hospital discharge in good health, which includes: * Return of bowel function * Resumption of oral feeding * Absence of early postoperative complications, particularly infectious complications (surgical site infection, intra-abdominal infection, sepsis)
Short-term complications
All early postoperative complications graded according to the Clavien-Madadi classification
Long-term complications
All late postoperative complications graded according to the Clavien-Madadi classification
Click on the lead sponsor to view all of their trials.
This trial is not recruiting at the moment. You can still explore other options:
