Comparison of Postoperative Outcomes of Duhamel and Transanal Endorectal Pull-Through in Hirschsprung Disease: A Propensity Score Study

Background/Objectives: Hirschsprung disease (HSCR) is a congenital condition characterized by absence of ganglion cells in the distal bowel. The principle of surgical treatment is resection of the aganglionic bowel with restoration of intestinal continuity. Several operative techniques have been developed. This study aimed to compare outcomes between the Duhamel procedure and transanal endorectal pull-through (TERPT) in Hirschsprung disease using propensity score-based methods. Methods: Hirschsprung patients who underwent Duhamel or TERPT from January 2006 to December 2021 were included. The primary outcome was a composite endpoint at 6 months comprising obstructive symptoms, fecal soiling, or Hirschsprung-associated enterocolitis. Propensity scores were estimated via logistic regression incorporating eight preoperative covariates. The primary analysis employed overlap weighting (ATO), with multiple sensitivity analyses performed to assess robustness. Results: A total of 239 patients were included (TERPT, n = 181; Duhamel, n = 58). Before weighting, seven of eight covariates demonstrated meaningful imbalance (SMD > 0.10); ATO weighting achieved satisfactory balance across all covariates (all SMD < 0.10). A good composite outcome was achieved in 51.9% of TERPT and 53.4% of Duhamel patients, with no significant difference in the primary ATO-weighted analysis (OR 0.94, 95% CI 0.39–2.28; p = 0.897). No significant differences were observed in individual outcome components. Findings were consistent across all sensitivity analyses. TERPT was associated with significantly shorter operative time, lower estimated blood loss, and shorter hospital stay (all p < 0.001). Conclusions: No statistically significant differences were detected in 6-month postoperative functional outcomes between TERPT and the Duhamel operation. TERPT was associated with improved perioperative outcomes. However, these findings should be interpreted with caution due to limited statistical power and baseline differences between groups. Prospective multicenter studies with standardized outcome definitions and longer follow-up are warranted.