LAPROSCOPIC ASSISTED SWENSON PULL-THROUGH FOR CLASSIC HIRSCHSPRUNG’S DISEASE WITH SIGMOID COLOSTOMY: A SINGLE CENTER EXPERIENCE

Abstract

OBJECTIVE: To share our experience of laparoscopic assisted Swenson pull-through for classic Hirschsprung’s disease (HD) with sigmoid colostomy. METHODS: Thirty-one patients with HD and sigmoid colostomy operated in Pediatric Surgery department, Khyber Teaching Hospital, Peshawar, Pakistan, between June 2014 and June 2018 were included. Patients with long segment HD, and those operated elsewhere were excluded from the study. Demographic characteristics, intraoperative findings and post operative course were retrieved from files. Post-operative outcome at 3rd, 6th and 12th month follow ups were taken from follow up charts. RESULTS: Mean age and weight of patients were 13.23±1.76 months and 7.89±1.42 kg, respectively. Male to female ratio was 6.75:1. Mean operative time, duration of urinary catheterization and hospital stay were 171.87±15.76 min, 0.79±1.02 days and 5.91±1.01 days, respectively. After surgery, stool consistency was liquid in 12 (61.29% ) and loose in 12 (38.7 %) patients. However, stool frequency was >3 times/day in 10 (32.25%) cases, 2-3 times/day in 18 (58.06%) patients and 0-1 time/day in 3 (9.67% ) patients. Surgical site infection and perianal excoriation were seen in 2 (6.45%) and 11 (35.48%) patients, respectively. Progressive improvement in stool consistency and frequency was noticed at 12th month follow up. Perianal excoriation was seen 11 (35.48%) patients at 3rd month, 6 (19.35% ) patients at 6th and 1 (3.22%) patient at 12th month follow up. CONCLUSION: Laparoscopic assisted Swenson pull-through is a good treatment option for patient with recto-sigmoid HD and bears a predictable and acceptable stooling pattern, optimum hospital stay and minimal complications.