A decade of experience with the primary pull-through for Hirschsprung disease in the newborn period - A multicenter analysis of outcomes

Objective To determine whether use of a primary pull-through would result i n equivalent perioperative and long-term complications compared with the tw o-stage approach. Summary Background Data During the past decade, the authors have advanced t he use of a primary pull-through for Hirschsprung disease in the newborn, a nd preliminary results have suggested excellent outcomes. Methods From May 1989 through September 1999, 78 infants underwent a primar y endorectal pull-through (ERPT) procedure at four pediatric surgical sites . Data were collected from medical records and a parental telephone intervi ew (if the child was older than 3 years) to assess stooling patterns. A sim ilar group of patients treated in a two-stage fashion served as a historica l control. Results Mean age at the time of ERPT was 17.8 days of life, Comparing prima ry ERPT with a two-stage approach showed a trend toward a higher incidence of enterocolitis in the primary ERPT group compared with those with a two-s tage approach (42.0% vs. 22.0%). Other complications were either lower in t he primary ERPT group or similar, including rate of soiling and development of a bower obstruction, Median number of stools per day was two at a mean follow-up of 4.1 +/- 2.5 years, with 83% having three or fewer stools per d ay. Conclusions Performance of a primary ERPT for Hirschsprung disease in the n ewborn is an excellent option. Results were comparable to those of the two- stage procedure. The greater incidence of enterocolitis appears to be due t o a lower threshold in diagnosing enterocolitis in more recent years.