Management of Hirschsprung's disease with reference to one-stage pull-through without colostomy

Background/Purpose: The authors evaluated the safety and benefits of 1-stag e pull-through in comparison with staged repair of Hirschsprung's disease u nder circumstances prevailing in a developing country. Methods: Forty-nine patients were treated for Hirschsprung's disease during a 7-year period between January 1991 and March 1998 at our institution, wh ich is a tertiary referral center. Nine patients were excluded from the stu dy, and the medical records of the remaining 40 patients were reviewed. Results: Eighteen patients including 7 neonates underwent 1-stage pull-thro ugh, and 22 patients underwent staged correction. There was no mortality fo r patients undergoing one-stage treatment, but there was 1 death caused by anastamotic leak after a 2-stage repair. There was no substantial differenc e in the incidence of complications (38.8% v 45.45%) and the need for addit ional surgical procedures (33.5% v 45.45%) between the 2 groups. Seventy-on e percent after 1-stage treatment and 80% after staged treatment had a sati sfactory functional result, and the incidence of incontinence was 14% and 1 0%, respectively. Overall, the incidence of postoperative enterocolitis was low (7.5%). Conclusions: One-stage correction of Hirschsprung's disease is a safe proce dure in all age groups. It offers economical and social advantages to famil ies in developing countries. Benefits of 1-stage treatment include avoidanc e of multiple operations, elimination of complications associated with a co lostomy, shorter duration of hospital stay, and completion of treatment at an earlier age. It is advisable to continue postoperative anal dilatation f or a minimum period of 6 months to 1 year to reduce the incidence of entero colitis, Copyright (C) 1999 by W.B. Saunders Company.