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Managing Hirschsprung's Disease without Routine Use of Post-Operative Anal Dilatation: Our Experience - Abstract

Anand Upasani, Thomas Tsang



Background: The current role of anal dilatation following pull-through for Hirschsprung’s disease is ambiguous and subjective. Regular postoperative anal dilatation program is widely practiced. It is unnecessary in all cases and can have potential physical as well as psychological side effects. This is a retrospective review of postoperative course and complications after pull-through procedure with particular reference to the need for routine postoperative anal dilatation.

Material and Methods: We retrospectively, reviewed the cases operated by a single surgeon over a period of 15 years. Postoperatively, all children were continued on low residue feeds. Features suggestive of early enterocolitis or gut dysmotility were used as criteria for instituting anal dilatation. The caliber of the anastomosis was not used as the deciding factor. Twenty case notes were reviewed with regards to postoperative course, use of daily anal dilatations and complications.

Results: Total 20 pull-through procedures were reviewed. Seventeen were males and 3 females. Enterocolitis was observed in 7 (35.0%) of the cases and constipation in 3 (15.0%). Considering the group without daily anal dilatation (n=15), only 2 (13.3%) had significant constipation and 2 (13.3%) developed enterocolitis, whereas all 5 children receiving daily anal dilatation experienced enterocolitis in the early course of management.

Conclusion: It is safe to manage pull-through patients without routine use of post-operative daily anal dilatation. In our cohort there was no anastomotic stricture. Enterocolitis and constipation were comparable to that reported in literature.

Keywords: Hirschsprung’s Disease, pull-through, anal dilatation


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