THE COLON PATCH GRAFT PROCEDURE FOR EXTENSIVE AGANGLIONOSIS - LONG-TERM FOLLOW-UP

Purpose: During the last 17 years, the authors have used the colon pat ch graft (CPG) procedure to treat 11 patients with extensive aganglion osis. This study evaluates the effectiveness of the CPG procedure in t reating patients with this disorder. Methods: An initial ileostomy was created during infancy in all 11 patients. At 1 to 21 months (mean, 5 .5 months) of age, an 11- to 40-cm (mean, 18 cm) side-to-side ileocolo stomy (CPG) was created between the ileum and aganglionic ascending co lon, (including aganglionic ileum in three patients). Ten patients lat er underwent a Swenson-type definitive operation, the CPG segment bein g brought down to the anus at 9 to 30 months (mean, 19 months) of age. These 10 patients have been followed up for growth, development, and bowel habit patterns for the subsequent 5 to 17 years (mean, 12 years) . Results: Within 1 month after the CPG was created, intravenous nutri tion could be discontinued and the patients treated at home until time for the definitive procedure. During this period, one patient died of aspiration. After the definitive operation, body weight for age retur ned to a normal range in 2 to 4 years. Currently, seven older patients have one to three bowel movements per day, whereas three younger pati ents have explosive diarrheal defecations. None are incontinent of sto ol. Iron deficiency anemia developed in four patients. Two are mentall y retarded, but the others are doing well in school. Conclusions: (1)T he colon patch graft procedure effectively reduces ''ileostomy diarrhe a,'' shortening the period of intravenous nutrition to 1 month, (2) bo wer habit patterns improve with the advance of time, (3) body weight f or age returns to normal 2 to 4 years after the definitive procedure, and (4) during long term follow-up, patients must be evaluated for iro n deficiency anemia. Copyright (C) 1988 by W.B. Saunders Company.