ONE-STAGE NEONATAL PULL-THROUGH TO TREAT HIRSCHSPRUNGS-DISEASE

Introduction: Traditionally Hirschsprung's disease has been treated by a three-stage procedure. This approach has been associated with stoma problems, three episodes of hospitalization, and a theoretical disadv antage, because of the delayed passage of feces via the rectum, in con trolling defecation. The aim of this study was to assess the results o f one-stage neonatal pull-through for the treatment of Hirschsprung's disease. Methods: This was a 10-year retrospective review of all patie nts treated with a neonatal pull through for Hirschsprung's disease. i nformation was obtained from the patients' records. All descriptive da ta are expressed as mean +/- standard deviation. Results: Fifty-one pa tients were treated in the 10-year period studied. The mean gestationa l age was 39.6 +/- 1.7 weeks, weight was 3.3 +/- 0.54 kg, with 76% bei ng boys. The surgery was performed at 10.3 +/- 5.8 days of age. A Swen son procedure was carried out in 38 patients and a Soave in 13. The ex tent of the disease Was rectosigmoid in 39, and the remaining were sig moid, descending colon, and total colonic. The mean length of the surg ery was 181 +/- 40 minutes. Blood transfusions were required in 13 pat ients with a mean volume of 55 mL given. The complications observed we re: an anastomotic leak in two cases, requiring laparotomy and colosto my (both in patients with Down's syndrome), and wound infection in thr ee cases. There were two delayed deaths both associated with other con genital anomalies. In total, three patients required further surgery; two had colostomies, one requiring a redd pull-through and one had an ileostomy for enterocolitis. The total length of hospital stay was 20. 4 +/- 11.2 days. Mean follow-up was 3.73 +/- 2.9 years. In 21 patients the follow-up was greater than 4 years End in this group none were to tally incontinent. Four patients complained of soiling at least once a week; and 17 had normal bowel control. Conclusion: Hirschsprung's dis ease can be successfully treated in the neonatal period with a one-sta ge pull-through. The short- and long-term results are as good as those with the three-stage procedure, with the child usually benefitting by not having a stoma and a shorter hospital stay. Copyright (C) 1997 by W.B. Saunders Company.