From
Dr. Nelson G. Rosen
Hirschsprung pull-through timing and the critical role of family irrigation training
hosted by Dr. Jill Knepprath
Chapter 1 of 4
Introduction
Introduction to Hirschsprung pull-through timing discussion
Expert statements on this page
No expert statements were drawn from this page.
Host summaries · secondary, not cited in answers
Educational content from recorded physician discussions — not medical advice. Talk to your (or your child's) care team about your situation.
Video
Update Course Rewind 2025: Hirschsprung’s Pull-Through: Why Family Training May Save Lives
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Hirschsprung Disease: Update Course 2015
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Update Course Rewind: 2020 Colorectal Part 1
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The Colorectal Quiz Episode 3.5: Proximal Hirschsprung Disease
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Hirschsprung Disease Rapid Fire: Update Course 2015
CCHMC Pediatric Surgery · 12 min · Published Nov 2015
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Error Traps and Culture of Safety in Hirschsprung Disease
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Pediatric Surgery Literature Updates: Lymphatic Malformations, G-Tube Complications, and Cryptorchidism Timing
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Botox injection during Hirschsprung pull-through: evidence and technique considerations
1 min · Published Nov 2026
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Colorectal Quiz Episode 50: Key Takeaways from the 16th European Pediatric Colorectal Conference
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Nerve monitoring and risk stratification in pediatric thyroid surgery
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What the experts said
In the literature, there is not really evidence of good timing to perform a pull-through procedure for Hirschsprung disease.
A 2021 PCPLC retrospective study compared outcomes of neonatal pull-through versus delayed primary pull-through for Hirschsprung disease.
One surgeon delays Hirschsprung pull-through at least 1 month, sometimes 3 months, depending on when the family can return, because they want families to demonstrate they can do irrigations at home.
Family competence in performing irrigations is an important skill for Hirschsprung management.
A family who is really good at irrigations will save a Hirschsprung baby's life.
Hirschsprung patients whose families cannot perform adequate washouts do not go home, are not adequately decompressed, and end up hospitalized with colitis or perforation.
In the PCPLC study, the median age of the neonatal pull-through group was 11 days at time of surgery compared to 98 days for the delayed group.
The PCPLC study found no difference in preoperative and postoperative enterocolitis or fecal incontinence at follow-up between neonatal and delayed pull-through groups.
Studies show no difference in complications between neonatal and delayed pull-through procedures for Hirschsprung patients.
Decisions on Hirschsprung pull-through timing should factor in the family's ability to perform irrigations.