Background <p>Surgical treatment of Hirschsprung disease (HD) has been performed through different techniques throughout the surgical history. All techniques evolve through a process of seeking optimal surgical outcomes. Our center has been using two main techniques to address the effects of Swenson and Rehbein’s procedure. Reports are inconclusive regarding which technique provides optimal outcomes.</p> Objectives <p>We aimed to review and compare outcomes between Swenson’s and Rehbein’s procedures in a sub-Saharan African cohort.</p> Methods <p>We reviewed records of patients who underwent Pullthrough (PT) surgery at a tertiary hospital. The primary outcome of the study was bowel performance following surgery. Chi X² and Fisher’s exact tests were used. Logistic regression analysis was carried out to detect any associations among the outcomes.</p> Results <p>Data from 55 patients were reviewed, and 49 were analyzed. These patients underwent surgery between January 1, 2018, and July 31, 2020. Thirty-one patients underwent the Swenson procedure. A total of 75% of the patients who underwent Swenson’s procedure had good bowel performance after surgery, whereas only 33% of those who underwent the Rehbein’s procedure had good bowel performance (<i>p</i> = 0.01). The two procedures were comparable in terms of the amount of time needed. The complication rate was higher in Rehbein’s procedure (77%, 14/19) than in Swenson’s procedure (41%, 13/31). Constipation and residual aganglionotic segments were found mainly during Rehbein’s procedure.</p> Conclusion and recommendation <p>The Swenson pull-through technique demonstrated superior outcomes compared to the Rehbein procedure, with fewer postoperative complications and improved bowel function. These findings support the Swenson approach as the preferred surgical option in our setting. Nonetheless, prospective studies are recommended to validate these results and explore long-term functional outcomes.</p>