Does surgical approach affect Hirschsprung-associated enterocolitis risk - A comparison between transanal Swenson-like and endorectal pull-throughs

Sep 30, 2026

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Hirschsprung-associated enterocolitis (HAEC) is a complication of Hirschsprung disease that can occur before or after surgery. This retrospective study compared HAEC incidence in HSCR patients undergoing transanal Swenson-like pull-through (TSLPT) versus transanal endorectal pull-through (TEPT) from 2018 to 2023. HAEC was scored using an HAEC scoring system with cut-offs of 4 and 10. Using cut-off ≥4, HAEC proportions were 24.4% (TEPT) and 6.9% (TSLPT); with cut-off ≥10, 9.8% and 3.4%. No statistically significant difference was found (p=0.056), but postoperative albumin correlated with HAEC in the TEPT group, and multivariate analysis supported albumin as a significant associated factor (p=0.047).

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CategoryHealthcare

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Abstract

Introduction

OPEN ACCESS Citation: Putri AFAP, Afandy D, Habibiy AZ, Nurhidayah SS, Vujira KA, Adhityo P, et al. (2026) Does surgical approach affect Hirschsprung-associated enterocolitis risk? A comparison between transanal Swenson-like and endorectal pull-throughs. PLoS One 21(1): e0340813. [https://doi.org/10.1371/journal](https://doi.org/10.1371/journal). pone.0340813 Editor: Kota V. Ramana, Noorda College of Osteopathic Medicine, UNITED STATES OF AMERICA Received: August 24, 2025 Accepted: December 27, 2025 Published: January 8, 2026 Peer Review History: PLOS recognizes the benefits of transparency in the peer review process; therefore, we enable the publication of all of the content of peer review and author responses alongside final, published articles. The editorial history of this article is available here: [https://doi.org/10.1371/journal](https://doi.org/10.1371/journal). pone.0340813 Copyright: © 2026 Putri et al. This is an open access article distributed under the terms of RESEARCH ARTICLE Does surgical approach affect Hirschsprungassociated enterocolitis risk? A comparison between transanal Swenson-like and endorectal pull-throughs Azzahra Fatinnuha Azmi Prayogi Putri1, Dwiki Afandy1, Ahmad Zakiy Habibiy1, Setiani Silvy Nurhidayah1, Khanza Adzkia Vujira1, Pramana Adhityo1, Gilang Vigorous Akbar Eka Candy1, Kristy Iskandar2, Eko Purnomo3, Gunadi1* 1 Pediatric Surgery Division, Department of Surgery, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, Indonesia, 2 Department of Child Health, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada/UGM Academic Hospital, Yogyakarta, Indonesia, 3 Pediatric Surgery Division, Department of Surgery, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/UGM Academic Hospital, Yogyakarta, Indonesia * [drgunadi@ugm.ac.id](drgunadi@ugm.ac.id) Abstract Hirschsprung-associated enterocolitis (HAEC) is a complication of Hirschsprung disease (HSCR) that may occur both before or after surgery. Transanal endorectal pullthrough (TEPT) is one of the standard treatments for HSCR. In addition, transanal Swenson-like pull-through (TSLPT) is a recent technique combining the Swenson method with the posterior sagittal approach. We aimed to compare the incidence of HAEC following TSLPT versus TEPT in HSCR patients and examine their association with predictor factors. We retrospectively reviewed the medical records of HSCR patients who underwent either TSLPT or TEPT at our institution between 2018 and 2023. The diagnosis of HAEC was established using an HAEC scoring system with cut-off values of 4 and 10. This study included 29 patients who underwent TSLPT and 41 who underwent TEPT. Using a cut-off of ≥4, the proportion of HAEC in TEPT and TSLPT was 24.4% and 6.9%, respectively. When applying the cut-off of ≥10, the proportion decreased to 9.8% in TEPT and 3.4% in TSLPT. There was no statistically significant difference in the incidence of HAEC between the TSLPT and TEPT groups (p = 0.056) . Postoperative albumin level was statistically associated with HAEC in the TEPT group (p = 0.03), but no other predictor factors, including sex, age at definitive surgery, type of aganglionosis, nutritional status, and postoperative hemoglobin level (p>0.05) . Subsequently, multivariate analysis indicated that albumin level was significantly associated with the occurrence of HAEC in HSCR patients following TEPT (p = 0.047) . In conclusion, our study suggests that the incidence of HAEC tends tobe higher following TEPT compared to TSLPT. Monitoring albumin levels postoperatively may be considered as a potential risk indicator for diagnosing HAEC in patients PLOS One | [https://doi.org/10.1371/journal.pone.0340813](https://doi.org/10.1371/journal.pone.0340813) January 8, 2026 1 / 12 the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any med

FAQs

What surgical techniques were compared in this study?

The study compared transanal Swenson-like pull-through (TSLPT) with transanal endorectal pull-through (TEPT) in patients with Hirschsprung disease.

How was HAEC diagnosed and scored?

HAEC diagnosis used an HAEC scoring system with cut-off values of 4 and 10.

Which predictor factor showed an association with HAEC after TEPT?

Postoperative albumin level was statistically associated with HAEC in the TEPT group, and multivariate analysis confirmed albumin as significantly associated (p=0.047).

Sep 30, 2026

Uploaded by dhado