Surgical Management of Hirschsprung’s Disease: Comparative Outcomes of Open Versus Minimally Invasive Approaches

Abstract

Background: Hirschsprung’s disease causes functional intestinal obstruction due to congenital a ganglionosis. Surgical resection remains definitive therapy, yet debate persists regarding optimal outcomes of open versus minimally invasive approaches. Objective: This study aims to compare perioperative and long-term functional outcomes between open pull-through and minimally invasive procedures for Hirschsprung’s disease, emphasizing complication rates, bowel function, and quality-of-life indicators. Methods: A prospective comparative study was conducted in the Department of Pediatric Surgery, Rajshahi Medical College, Bangladesh, from January 2023 to June 2024. A total of 126 patients diagnosed with Hirschsprung’s disease were randomized into open (n=64) and minimally invasive (n=62) groups. Clinical, perioperative, and functional outcome data were analyzed using descriptive statistics, standard deviations, and chi-square tests. Results: Mean operative time was significantly shorter in the minimally invasive group (95.3±14.2 minutes) compared to open surgery (128.7±16.9 minutes; p<0.001). Postoperative hospital stay averaged 5.1±1.4 days versus 8.4±2.1 days (p<0.01). Early postoperative complications occurred in 14.5% (9/62) of minimally invasive cases versus 26.5% (17/64) of open (p=0.04). Incidence of Hirschsprung-associated enterocolitis was lower in minimally invasive patients (12.9%) compared to open (23.4%), though not statistically significant (p=0.08). At 12-month follow-up, satisfactory bowel function was achieved in 85.4% (53/62) of minimally invasive versus 71.9% (46/64) of open cases (p=0.03). Overall mortality was 1.6% (2/126). Conclusion: Minimally invasive surgery demonstrates superior short-term recovery, fewer complications, and improved bowel function compared with open techniques, reinforcing its role as the preferred approach in Hirschsprung’s disease management.