Gunadi et al. BMC Gastroenterol (2021) 21:85 https://doi.org/10.1186/s12876-021-01668-x RESEARCH ARTICLE Functional outcomes of patients with short-segment Hirschsprung disease after transanal endorectal pull-through Gunadi * , Gabriele Ivana, Desyifa Annisa Mursalin, Ririd Tri Pitaka, Muhammad Wildan Zain, Dyah Ayu Puspitarani, Dwiki Afandy, Susan Simanjaya, Andi Dwihantoro and Akhmad Makhmudi Abstract Background: Transanal endorectal pull-through (TEPT) is considered the most preferable treatment method for Hirschsprung disease (HSCR) since it is less invasive and has fewer morbidities than transabdominal pull-through. Here, functional outcomes in short-segment HSCR patients after TEPT were assessed and associated with the prog- nostic factors. Methods: Krickenbeck classification was used to assess the functional outcomes in patients with HSCR after TEPT surgery at our institution from 2012 to 2020. Results: Fifty patients were involved in this study. Voluntary bowel movement (VBM) was achieved in 82% of sub- jects. Nine (18%) subjects had soiling grade 1, while two (4%) and two (4%) patients suffered constipation that was manageable with diet and laxative agents, respectively. Patients who underwent TEPT at ≥ 4 years old tended to have soiling more than patients who underwent TEPT at < 4 years old (OR = 16.47 [95% CI 0.9–301.61]; p = 0.06), whereas patients with post-operative complications had 10.5-fold higher risk for constipation than patients without post-oper- ative complications (p = 0.037; 95% CI 1.15–95.92). Multivariate analysis showed male sex was significantly associated with VBM (OR = 9.25 [95% CI 1.34–63.77]; p = 0.024), while post-operative complications were strongly correlated with constipation (OR = 10 [95% CI 1.09–91.44]; p = 0.04). Conclusions: The functional outcomes of HSCR patients after TEPT in our institution are considered relatively good. Moreover, the VBM, soiling, and constipation risk after TEPT might be affected by sex, age at TEPT performed, and post-operative complications, respectively, while the age at TEPT performed might not be associated with functional outcomes. Further multicenter studies with a larger sample size are necessary to clarify and confirm our findings. Keywords: Age at pull-through performed, Hirschsprung disease, Post-operative complications, Transanal endorectal pull-through © The Author(s) 2021. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativeco mmons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Introduction Hirschsprung disease (HSCR) is a complex genetic anomaly, characterized by the absence of ganglion cells at the myenteric and submucosal plexus of the intestines, resulting in functional obstruction [1]. HSCR can be clas- sifed based on aganglionosis length into three categories: (1) short-segment, (2) long-segment, and (3) total colon aganglionosis [1, 2]. Te incidence of HSCR is about 1:5000 per live births [1, 4], while in Yogyakarta, Indone- sia, its incidence is 1:3,250 live births [3]. Te goal of surgical management for HSCR is to remove the aganglionic colon and make an anastomosis above the dentate line to re-establish bowel continuity Open Access *Correspondence: drgunadi@ugm.ac.id Pediatric Surgery Division, Department of Surgery, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Jl. Kesehatan No. 1, Yogyakarta 55281, Indonesia