INITIAL EXPERIENCE WITH ONE-STAGE ENDORECTAL PULL-THROUGH PROCEDURES FOR HIRSCHSPRUNGS-DISEASE

To evaluate our experience with one-stage endorectal pull-through (ERP T) procedures (without colostomy) for Hirschsprung's disease (HD), we compared 7 such patients to a cohort of 20 consecutive patients underg oing ERPT following colostomy. Reasons for exclusion from the cohort g roup included: (1) bowel obstruction requiring operation before 1 mont h of age; (2) presentation with enterocolitis (EC), intestinal perfora tion, or massive fecal distension; (3) long-segment disease; or (4) se vere associated anomalies. The 7 male patients in the single-stage ERP T group first presented at a median ape of 16 days (4 days-2.5 years) and were managed by regular digital dilation or colonic irrigation for between 1 and 6 months (median 2 months) prior to surgery. Single-sta ge procedures were performed at a median age and weight of 4 months (2 months-2.5 years) and 6.4 kg (4.5-13.8 kg), respectively. Median hosp italization for these patients was 9 days. Postoperative complications occurred in 2 patients (29%), and included anastomotic stricture requ iring outpatient dilation, and 1 case of recurrent EC that responded t o a course of anal dilations. The cohort group (14 M, 6 F) presented a t a median of 15 months. All underwent colostomy as a primary procedur e. ERPT was deferred until a median age of 21 months, and the hospital ization after pull-through averaged 10 days (20 days including stay af ter colostomy). Four patient (20%) developed complications requiring r eoperation following the initial colostomy. Complications after ERPT o ccurred in 5 patients (25%) and included 1 death from fulminant Hirsch sprung's EC. Other complications included 1 anastomotic stricture and 2 mucosal prolapses requiring anoplasty. Long-term functional results were similar in both groups. Despite our limited experience, we conclu de that one-stage ERPT can be safely performed in infants, including t hose under 3 months of age, with rectosigmoid HD. Total duration of ho spitalization is reduced and colostomy complications are avoided. Func tional outcome appears to be comparable between patients treated in on e or two stages.