Course and Management of Hirschsprung's Disease, and Treatment of Hirschsprung's Disease by Swenson's Operation

Abstract

These articles describe an experience with 152 cases of Hirschsprung's disease treated in the Hospital for Sick Children, Great Ormond Street, since 1948. The first paper discusses the clinical features, diagnosis, differential diagnosis and management prior to surgery. The second paper describes the results of excision of the aganglionic segment by the procedure of Swenson in these 152 cases. The operative mortality was 4%. In 35 cases some postoperative complications occurred either early or late. The different types of complications are enumerated and discussed. Of 102 patients, whose ages range from 3 to 22 years, and therefore could be expected to be fully continent, 55 are normal in every way. The remainder still have some deficiency, although slight, and in many the result could be considered satisfactory except by the most critical criteria. Troublesome constipation was a common postoperative problem and required treatment in 34 of the cases. The management of this is fully discussed along with possible explanations. Revision operations were required in only 3 cases. This extensive series provides an excellent depiction of the clinical features of Hirschsprung's disease and its successful treatment by Swenson's procedure and a helpful consideration of the postoperative management.