TÇCD 2011 29. National Pediatric Surgery Congress and 27. National Congress of The Egyptian Pediatric Surgical Association

 

Background

The aim of this study was to evaluate the functional outcome  after a one-stage transanal pull-through operation for Hirschsprung's disease in children , with specific emphasis on the importance of the dilated segment above the cone of transition.

Methods

Two hundred and three patients  who underwent a one-stage transanal pull-through operation for Hirschsprung's disease were followed up for 6 -24 months. The children (156 boys and 47 girls) were from 1 month to 7 years of age (mean age, 1.2 years). All patients had an aganglionic segment confined to the rectosigmoid area (confirmed by preoperative barium enema and postoperative histology).long segment disease was excluded from the study. In all cases, the dilated ecstatic segment above the area of aganglionosis was resected  Clinical outcome was assessed by interviews and questionnaires, Contrast barium enema was performed on all children postoperatively.

 

Results

The stooling patterns were considered satisfactory in 82% children. Of all the children, the mean stool times were 1 to 2 per day 6 months postoperatively, and transient postoperative soiling was found in 7%. Constipation was observed in 11%, and Hirschsprung’s-associated enterocolitis in 23%. There was no cases of frank incontinence, cuff infection, or mortality noted .One case in the early series had anastomotic leak, one had fecal umbilical fistula secondary to untreated enterocolitis. Barium enema showed that the dilated and spastic colonic segment disappeared in all children. The dilated sigmoid loops disappeared in all cases on postoperative barium enema.

Conclusions

Patients with Hirschsprung’s disease have normal anal sphincter mechanism, and it should be expected that the majority of patients have perfect continence after operation.

The Transanal pull through for classical rectosigmoid Hirschsprung’s disease has proved excellent functional results in the short and medium term follow up. Attention to certain technical details, specifically using minimal anal dilatation during the procedure, will help improve the results and avoid incontinence. The removal of the dilated segment above the area of aganglionosis is of paramount importance to achieve best functional results.