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What Is Hirschsprung Disease Pull-Through Surgery?

Hirschsprung disease pull-through surgery removes the segment of intestine that lacks normal enteric nerve cells and connects normally innervated bowel to the anus. The operation treats the functional obstruction caused by aganglionosis in Hirschsprung disease. Several established techniques are used, including the Swenson, Soave, and Duhamel procedures, each creating the final bowel connection in a different way. Many children can undergo a one-stage transanal or laparoscopic-assisted pull-through, while others need a temporary ostomy before definitive repair.

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What Is Hirschsprung Disease Pull-Through Surgery?

Hirschsprung disease pull-through surgery removes the segment of intestine that lacks normal enteric nerve cells and connects normally innervated bowel to the anus. The operation treats the functional obstruction caused by aganglionosis in Hirschsprung disease. Several established techniques are used, including the Swenson, Soave, and Duhamel procedures, each creating the final bowel connection in a different way. Many children can undergo a one-stage transanal or laparoscopic-assisted pull-through, while others need a temporary ostomy before definitive repair.

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Why Is Hirschsprung Disease Pull-Through Surgery Performed?

Hirschsprung disease causes a segment of large intestine to remain tightly contracted because ganglion cells are absent from the bowel wall. Stool and gas cannot pass normally through the affected segment, leading to obstruction, abdominal swelling, constipation, vomiting, or Hirschsprung-associated enterocolitis. Pull-through surgery removes the aganglionic bowel and places healthy ganglionated intestine in continuity with the anus. A temporary ostomy can be performed first when a child has severe enterocolitis, perforation, marked bowel dilation, poor clinical condition, or very extensive disease.

How Is Hirschsprung Disease Pull-Through Surgery Performed?

The surgeon identifies the transition between aganglionic and normally innervated bowel, often using pathology from intraoperative biopsies to confirm adequate ganglion cells. The abnormal distal bowel is removed or bypassed according to the chosen technique, and healthy bowel is pulled down to the anus. A Swenson procedure creates a direct low anastomosis after removing the diseased rectum, while Soave leaves a muscular cuff and Duhamel creates a side-to-side pathway behind the retained rectum. The operation can be performed transanally, laparoscopically, through an open abdominal approach, or with a combination of techniques.

What Is Recovery Like After Hirschsprung Disease Pull-Through Surgery?

After surgery, the care team monitors bowel movements, abdominal swelling, feeding tolerance, hydration, wound healing, and signs of enterocolitis. Stool frequency can be high initially and can cause significant diaper-area skin irritation in infants. Bowel function often improves over time, but some children continue to experience constipation, soiling, obstructive symptoms, or difficulty with continence. Long-term pediatric colorectal follow-up helps identify anatomical problems, abnormal motility, sphincter dysfunction, or recurrent enterocolitis that can require further treatment.

What Are the Risks and Complications?

Possible surgical complications include bleeding, infection, anastomotic leakage, stricture, bowel obstruction, and injury to nearby pelvic structures. Hirschsprung-associated enterocolitis can occur even after a technically successful pull-through and requires prompt treatment because it can become life-threatening. Persistent obstructive symptoms can result from a tight anastomosis, retained aganglionic or transition-zone bowel, a problematic muscular cuff, or abnormal bowel motility. Some patients also develop chronic constipation, fecal soiling, or continence problems that require ongoing bowel-management care.

Frequently Asked Questions About Hirschsprung Disease Pull-Through Surgery

What are the main types of Hirschsprung pull-through surgery?

The major named techniques are Swenson, Soave, and Duhamel pull-through procedures, with variations performed transanally, laparoscopically, or through an open approach.

Does every child need an ostomy before pull-through surgery?

No. Many children undergo a one-stage pull-through, while an ostomy is used first when severe enterocolitis, perforation, major bowel dilation, or other clinical factors make staged treatment safer.

Can enterocolitis occur after a pull-through?

Yes. Hirschsprung-associated enterocolitis can occur after surgery and can cause fever, abdominal distension, diarrhea, vomiting, or serious illness requiring urgent medical care.

Can bowel problems continue after Hirschsprung surgery?

Yes. Some children have persistent constipation, obstructive symptoms, soiling, or continence problems and benefit from long-term pediatric colorectal follow-up.

References

Treatment for Hirschsprung Disease. National Institute of Diabetes and Digestive and Kidney Diseases. https://www.niddk.nih.gov/health-information/digestive-diseases/hirschsprung-disease/treatment. Date Accessed September 11, 2026.

Hirschsprung's disease associated enterocolitis: A comprehensive review. PubMed. https://pubmed.ncbi.nlm.nih.gov/37342453/. Date Accessed September 11, 2026.

Evaluation and treatment of the post pull-through Hirschsprung patient who is not doing well; Update for 2022. PubMed. https://pubmed.ncbi.nlm.nih.gov/35690463/. Date Accessed September 11, 2026.

Guidelines for the management of postoperative obstructive symptoms in children with Hirschsprung disease. PubMed. https://pubmed.ncbi.nlm.nih.gov/28180937/. Date Accessed September 11, 2026.

Duhamel and Transanal Endorectal Pull-throughs for Hirschsprung' Disease: A Systematic Review and Meta-analysis. PubMed. https://pubmed.ncbi.nlm.nih.gov/28958095/. Date Accessed September 11, 2026.