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Single Stage Transanal Endorectal Pull-Through for Management of Hirschprung’s Disease (Abstract)

Rakesh Handa¹, Man Mohan Harjai²

¹. Department of Pediatric Surgery, Max Healthcare and Kailash Group of Hospitals

². Department of Pediatric Surgery, Surgical Division, Base Hospital Delhi Cantt

New Delhi, India

 

Abstract

Introduction: Over the years, the surgical management of recto-sigmoid Hirschsprung’s disease (HD) has evolved radically and at present a single stage transanal pull-through can be done in suitable cases, which obviates the need for multiple surgeries and blood transfusion.

Material and Methods: A retrospective analysis (between January 2003 and November 2005) was carried out on all cases of Hirschsprung’s reporting to a tertiary care hospital that were managed by transanal pull-through as a definitive treatment. All selected patients including neonates had an aganglionic segment confined to the rectosigmoid area, confirmed by preoperative barium enema and postoperative histology. All children had their operation done without construction of prior colostomy. We relied on the level indicated on a barium enema as well as clinical intra-operative assessment since we were lacking the facilities of frozen section.

Results: Transanal pull-through was performed in 14 children including 5 neonates. Mean operating time was 100 minutes (range 64 to 135 minutes). No patients required laparotomy because all patients including neonates had an aganglionic segment confined to the rectosigmoid area. Blood loss ranged between 20 to 85 ml with blood replacement required in 2 cases. Since all children were given an epidural caudal block, the requirement of analgesia in these cases was minimal. Postoperative complications included perianal excoriation in 11 out of 14 (78.5%) patients lasting from 3 weeks to 6 months, which included all neonates (n=5). Complete anorectal continence was noted in 10 of 14 (71.3%) children in follow up of 3 – 5 years, whereas 3 other patients showed a steady improvement in their continence status.

Conclusions: We believe that this procedure can be safely conducted based on the clinical expertise and experience which all pediatric surgeons possess since they regularly perform leveling colostomies in Hirschsprung’s disease. This can be confidently performed even in hospitals that do not have facilities for frozen section.

Key words: Single stage, transanal, pull through procedure, Hirschsprung’s disease, frozen section biopsy, perianal excoriations.

 

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