• Dhruva N Ghosh, Yingrui Liu, Daniel T Cass, and SoundappanSoundappan S VSSVDepartment of Surgery, The Children's Hospital at Westmead, Sydney, New South Wales, Australia..
• Department of Surgery, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.
• ANZ J Surg. 2017 Oct 1; 87 (10): 780-783.

BackgroundPull-through of ganglionic bowel is essential for successful treatment of Hirschsprung's disease. We studied the incidence of transition zone pull-through in our institution and compared its outcome with ganglionic bowel pull-through.MethodsChildren who underwent Soave's pull-through for Hirschsprung's disease from January 2005 to November 2012 were studied. Patients were divided into two groups: ganglionic bowel pull-throughs (Group 1) and transition zone pull-throughs (Group 2). Demographics, presentations, surgical procedure, post-operative results and complications including redo procedures were recorded and reviewed along with histopathology reports.ResultsFifty patients underwent Soave's pull-through for Hirschsprung's disease in our group. The median age at surgery was 13.5 days in Group 1 and 22.5 days in Group 2. Transition zone pull-through occurred in eight children (16%). Transition zone pull-through was attributed to errors in histologic interpretation (n = 5), sampling (n = 2) and surgical technique (n = 1). The transition zone was significantly longer in Group 2 (P = 0.002). Constipation and enterocolitis were the main complications needing therapy. One child in Group 2 required surgery for adhesive intestinal obstruction.ConclusionsThe length of the transition zone in children with transition zone pull-through was significantly longer. Though our children with transition zone pull-through did not require redo surgery the possibility of redo surgery remains. Transition zone pull-through should still be considered an error and should be prevented.© 2016 Royal Australasian College of Surgeons.

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