Update Course Rewind 2025: Hirschsprung’s Pull-Through: Why Family Training May Save Lives
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Topic overview
In this Update Course Rewind from the 13th Annual Update Course in Pediatric Surgery, Drs. Nelson Rosen, Annie Le-Nguyen, Aaron Garrison, Jamie Harris, and Elizabeth Speck discuss one of the most common questions in Hirschsprung disease management: when is the best time to perform a pull-through procedure?
Key Highlights:
Neonatal vs Delayed Pull-Through:
A recent PCPLC retrospective study compared neonatal pull-throughs to delayed procedures and found no significant difference in enterocolitis rates, postoperative complications, or long-term fecal continence outcomes.
Timing Remains Flexible:
The neonatal group underwent surgery at a median age of 11 days, while delayed repairs occurred closer to 3 months—highlighting the wide variation in current practice.
Importance of Home Irrigations:
Panelists emphasized that family ability to perform effective rectal irrigations is often more important than patient age when determining timing of surgery.
Preventing Enterocolitis:
Families who are well-trained in washouts can help prevent dangerous complications like enterocolitis and perforation by maintaining adequate decompression at home.
Patient- and Family-Centered Decision Making:
Factors such as caregiver comfort, access to follow-up, and successful irrigation education should guide operative timing rather than a strict protocol.
This session highlights that successful Hirschsprung management depends not only on surgical timing, but also on empowering families with the skills needed for safe home care.
Intended audience: Healthcare professionals and clinicians.
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