Abstract
Background: Primary endorectal pull-through is becoming a standard of care across the globe. This study was done to compare the outcome of patients with Hirschsprung’s disease (HD) who underwent primary endorectal pull-through with patients who were treated with a staged approach. Methods: A retrospective data review was done of all patients diagnosed with Hirschsprung’s disease (HD) at Tygerberg Children’s Hospital, a tertiary hospital in Cape Town, during an 11-year period (2007 – 2018). The patients were divided into 2 groups: the primary Endorectal pull-through (ERP) group and the staged group and the two groups were compared. Results: Eighty patients with histologically confirmed Hirschsprung’s disease (HD) were seen at our institution during the study period (2007 – 2018). Four patients did not meet the inclusion criteria and were excluded. Of the remaining seventy-six who were included, forty-six patients (60.5%) had a primary endorectal-pull through (Primary group) and thirty patients (39.5%) had staged procedures (Staged group) with a stoma before the final ERP. The peri-operative complications were subdivided into major and minor complications. Minor perioperative complications in the primary group were less (13%) compared to the staged group (33%) with a p-value of 0.017, making the difference statistically significant. Anastomotic strictures were the most common complication in both groups with abdominal wound infection being more common in the staged group. The late complications were similar in both groups with a p-value of 0.43. Constipation was the most common complication in both groups, followed by soiling. Conclusion: The two groups had a similar outcome without statistically significant differences. We can safely conclude that the primary endorectal pull-through for HD is at least as safe as the staged approach in Sub- Saharan Africa. With this technique, we avoid a stoma and the necessity for two surgical procedures with added potential complications.
Highlights
Hirschsprung’s disease (HD) is a congenital condition characterized by the absence of ganglion cells in the submucosal (Meissner’s) and myenteric plexus of the distal bowel. [1,2] It is more common in males (M:F=3.2:1) and is the most common cause of distal bowel obstruction in both neonates and older children.[1,3]
Long segment HD can be further subdivided into long segment colonic aganglionosis, total colonic aganglionosis, and small bowel aganglionosis.[4]
Various surgical methods have been described over the years for definitive surgery, with endorectal pull-through (ERP) being the latest addition
Summary
Hirschsprung’s disease (HD) is a congenital condition characterized by the absence of ganglion cells in the submucosal (Meissner’s) and myenteric plexus of the distal bowel. [1,2] It is more common in males (M:F=3.2:1) and is the most common cause of distal bowel obstruction in both neonates and older children.[1,3]HD can be classified as short-segment (recto-sigmoid) and long-segment HD. De la Torre-Mondragon and J.A. Ortega –Salgado first described this method in 1998, which has since become the most popular surgery for short segment Hirschsprung’s disease worldwide.[1,5,6] ERP is a minimally invasive technique, executed meticulously with good results. Ortega –Salgado first described this method in 1998, which has since become the most popular surgery for short segment Hirschsprung’s disease worldwide.[1,5,6] ERP is a minimally invasive technique, executed meticulously with good results Both single and multicentric studies have shown it to be safe, easy to master, without potential risks of complications related to the laparotomy and stoma.[7,8,9]. This study was done to compare the outcome of patients with Hirschsprung’s disease (HD) who underwent primary endorectal pull-through with patients who were treated with a staged approach
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