Laparoscopic Pull-Through Surgery for Hirschsprung Disease

Our experienced pediatric surgeons are skilled in surgical procedures to treat Hirschsprung disease, a disorder that affects nerve cells in a child’s intestine. At the Colorectal and Pelvic Center at Children's Health℠, our multispecialty team diagnoses and treats Hirschsprung disease and other complex conditions of the digestive system. We bring together our expertise from several medical fields to provide compassionate care to improve your child’s health, well-being and quality of life.

What is Laparoscopic Pull-Through Surgery for Hirschsprung Disease?

Children who are born with Hirschsprung disease are missing certain nerve cells in the intestine, most commonly the large intestine. The condition affects the coordinated squeezing action called peristalsis, which moves stool (poop) through the intestines. Hirschsprung disease slows or stops stool from moving through, and the intestine becomes blocked.

To help your child have normal bowel movements, our surgeons perform a minimally invasive procedure. Surgeons first remove the section of the intestine that is missing nerve cells. They connect the healthy section to the anus (end of the large intestine where stool exits the body). In many cases, our surgeons perform this procedure in a single operation.

What are the benefits of Laparoscopic Pull-Through Surgery for Hirschsprung Disease?

The key benefit of the laparoscopic pull-through procedure is that it removes the section of intestine with missing nerve cells to remove the blockage. After the procedure, the child will have bowel movements more easily as stool moves more normally through the intestines and out of the body through the anus.

The laparoscopic pull-through is a minimally invasive procedure that requires a few tiny incisions (cuts) on the abdomen (belly) to access the treatment area. In some cases, we may perform this procedure through the anus (transanal approach), which requires no incisions on the abdomen.

Benefits of our minimally invasive approaches include:

  • Less bleeding and scarring
  • A shorter hospital stay and recovery time
  • Less pain after surgery

What are the risks of Laparoscopic Pull-Through Surgery for Hirschsprung Disease?

Your child’s care team works carefully to minimize any risks of complications with a laparoscopic pull-through procedure. Our surgeons and their teams have years of experience performing this procedure on infants and young children, which reduces the risk of potential complications. If a problem occurs, we quickly take steps to protect your child’s health.

Your child’s care team will discuss possible risks of a laparoscopic pull-through surgery with you before the procedure. In general, risks may include:

  • Bleeding from the surgical site
  • Infection after surgery
  • Reaction to anesthesia (medicine to put your child into a sleeplike state for surgery)
  • Excessive pain
  • Wound breakdown
  • Skin irritation or breakdown on the buttocks
  • Stricture (narrowing) in the anus
  • Fecal incontinence (soiling) or difficulty with stooling, which may require bowel management or additional procedures

After pull-through surgery, children with Hirschsprung’s disease can still develop enterocolitis, an infection in the large intestine. Learn more about Hirschsprung’s disease and how we manage related issues such as enterocolitis.

What to expect with Laparoscopic Pull-Through Surgery for Hirschsprung Disease

Your child may need one or more surgeries over several months to fully repair the large intestine, depending on how much of the intestine is affected by Hirschsprung disease. The disease may affect only the rectum (lower end of the large intestine), a large section of the large intestine, the entire large intestine or, in very rare cases, part or all of the small intestine.

At the Colorectal and Pelvic Center, our surgeons have the expertise to treat all types of Hirschsprung disease, whether it affects a short segment or the entire small and large intestine. Whenever possible, we perform a single-stage operation to reconstruct the intestine. We work closely with you and your family to help you understand your child’s specific needs and decide on the right treatment options for them.

What to expect before Laparoscopic Pull-Through Surgery for Hirschsprung Disease

If needed, your child may have an ostomy as the first stage of treatment. In this procedure, the surgeon creates an opening in the belly and connects the intestine to it. Your child will have a collection bag attached to the opening to collect stool as it leaves the body.

With an ostomy, your child can eat and digest normally, and they will continue to grow before the laparoscopic pull-through procedure.

What to expect during Laparoscopic Pull-Through Surgery for Hirschsprung Disease

Often, our surgeons can perform this procedure shortly after birth, when we first diagnose Hirschsprung disease, so your child may not need an ostomy. First, our surgeons take one or more tissue samples (biopsy) of your child's intestines to identify the areas that lack nerve cells.

The surgeons then remove the diseased sections of intestine using a scope (narrow camera) and surgical instruments inserted through small incisions. When possible, we perform the pull-through procedure entirely through the child's anus, which requires no incisions and leaves no scars.

We then attach the end of the remaining, healthy intestine to the child's anus to construct a fully functioning large intestine (and part of the small intestine, if needed). By removing the part where nerve cells are missing, we ensure that the remaining large intestine has working nerve cells for proper bowel function.

If your child had an ostomy as the first stage of surgery, our surgeons sometimes close it during the pull-through procedure. In other cases, we close the ostomy in a separate procedure several weeks after the pull-through procedure, once the anal area has healed.

What to expect after Laparoscopic Pull-Through Surgery for Hirschsprung Disease

Most children need to stay in the hospital for a few days after a laparoscopic pull-through procedure for Hirschsprung disease. Before you leave the hospital, your child’s care team will provide you with complete instructions for how to care for your child at home.

Because your child will likely pass several stools a day at first, the skin around their anus may become irritated (severe diaper rash). We will teach you how to care for the skin in that area and how to keep any abdominal incisions clean and dry.

What questions should I ask my provider about Laparoscopic Pull-Through Surgery for Hirschsprung Disease?

As you decide on treatment options for your child, you may want to ask the care team questions such as:

  • Are there other treatment options for Hirschsprung disease?
  • What medications should my child stop taking before the procedure?
  • How soon will I be able to see my child after the procedure?
  • How long will my child need to stay in the hospital after a laparoscopic pull-through procedure for Hirschsprung disease?
  • Will my child go home with any special equipment after the procedure?

Laparoscopic Pull-Through Surgery for Hirschsprung Disease Doctors and Providers

Our multispecialty team works together to help children overcome even the most complex types of Hirschsprung disease and other digestive disorders. We’ll stay by your side, every step of the way, to provide the care your child needs to achieve their best health.

Frequently Asked Questions

  • Will my child have bowel issues after laparoscopic pull-through for Hirschsprung disease?

    Most children heal well from the procedure without complications. At first, your child may have frequent, loose stools, so it’s important to take good care of their skin to help prevent severe diaper rash.

    An intestinal infection, Hirschsprung-associated enterocolitis (HAEC), can occur even after surgery. Although HAEC usually stops as a child gets older, it can become life-threatening. We can quickly treat HAEC with antibiotics, so please contact us immediately if your child experiences symptoms such as:

    • Fever
    • Abdominal (belly) swelling
    • Explosive and watery diarrhea
    • Bleeding from the rectum
    • Vomiting

    For toilet training your child, you can start at the usual age, when they are age 2 to 3. A child who has Hirschsprung disease may take longer to control their bowel movements. At our Colorectal and Pelvic Center, we offer a comprehensive bowel management program to help your child achieve bowel control and avoid constipation or stool accidents. We work closely with you and your child to customize a program specifically for their unique needs.

  • What should my child eat and drink after laparoscopic pull-through for Hirschsprung disease?

    Children usually don’t need to follow a special diet after surgery for Hirschsprung disease. Some types of Hirschsprung disease affect a child’s entire large intestine and part of the small intestine. After surgery to remove the affected parts of the intestines, a child may have problems getting enough nutrients and may need nutritional support or other treatments. Our care team can connect you with registered dietitians at Children’s Health for nutritional planning.

  • Will my child need lifelong care after surgery for Hirschsprung disease?

    Children born with Hirschsprung disease need ongoing follow-up care. Some children may experience severe constipation and bowel incontinence, which, if not treated promptly, can lead to more serious conditions. Your child may need additional surgeries later in life to treat these issues. It’s important to continue to bring them to the Colorectal and Pelvic Center for follow-up care, where we can adjust their care plan as needed.

    Some children may develop issues with body self-image and may benefit from psychological support. Our center offers access to pediatric psychologists, Child Life specialists and social workers for therapy and other services. Being proactive can empower young adults to take a larger role in managing their own condition, which can result in lifelong health benefits.

    As your child becomes an adult, their health needs change. We can help your child transition to an adult care provider with experience in treating adults with Hirschsprung disease. Some adults who received care for this condition as children may experience continuing bowel issues. That’s why it’s critical that they receive ongoing care throughout their lives.