Abstract
Objective: Hirschsprung’s disease is one of the common causes of intestinal obstruction in neonates. Transanal endorectal pull-through represents the latest development in the concept of the minimally invasive surgery for Hirschsprung’s disease. In this study, we present our early experience with single stage transanal pull through in neonates. Design: Retrospective study of neonates with single stage transanal pull-through done for Hirschsprung’s disease in our institute from January 2011 to January 2013. Material and Method: Five newborn boys who presented with Hirschsprung’s disease were studied. The selection criteria included radiological transition zone at rectosigmoid or mid-sigmoid region, weight more than 2 kg, no evidence of enterocolitis or sepsis and no associated major anomaly. Single stage transanal endorectal pull-through was done in these patients. The follow-up period ranged from 6 months to 2 years. Results: Five patients with a mean age of 26.4 days (range 15-45 days) and a mean weight of 2.6 Kg (range 2.2 to 3.7 Kg) underwent transanal endorectal pull through. The mean operating time was 68 min (range 60 to 120 min). The average intra-operative blood loss was 20 ml (range – 10 to 30 ml) and the average length of bowel resected was 12.8 cm (range – 10 to 18 cm). Post-operatively patients passed first stool between 2nd and 3rd day. Oral feeding was resumed on 5th to 6th post-operative day. The average post-operative duration of stay in hospital was 10 days. None of the patients had post-operative bleeding, urethral injury, anastomotic leak or retraction of anastomotic site. Three patients developed perianal excoriation and one patient had post-operative enterocolitis. No mortality occurred in the series. Conclusion: Advancement in pediatric anaesthesia, availability of pediatric surgical expertise, improvement in pre-operative and post-operative management and nursing care has made single stage transanal pull-through in neonates a feasible option. The early results are comparable to single stage or multistage surgery in older children.
Highlights
Hirschsprung’s disease is one of the common causes of intestinal obstruction in neonates. [1] There have been considerable advances in the management and correction of Hirschsprung’s disease since Swenson first described the pathological basis of the disease. [2] In the Standard surgical teaching advocates that a proximal diverting colostomy should be done at the time of diagnosis and the child be allowedEL-MED-Pub Publishers. http://www.elmedpub.com to grow before performing a definitive pullthrough
The early results are comparable to single stage or multistage surgery in older children
We present our early experience with single stage transanal pull through in neonates and its feasibility with respect to peri-operative, post-operative course and early outcome
Summary
Hirschsprung’s disease is one of the common causes of intestinal obstruction in neonates. [1] There have been considerable advances in the management and correction of Hirschsprung’s disease since Swenson first described the pathological basis of the disease. [2] In the Standard surgical teaching advocates that a proximal diverting colostomy should be done at the time of diagnosis and the child be allowedEL-MED-Pub Publishers. http://www.elmedpub.com to grow before performing a definitive pullthrough. Single stage transanal pull-through for the management of Hirschsprung’s disease was almost concurrently described by de la TorreMondregon, Ortega-Salgado [3] and by Langer et al [4] in 1998 and 1999 respectively. In neonates, this procedure is beneficial as the dissection is easier due to the fact that the colon above the aganglionic segment is not much dilated and there are fewer or no episodes of enterocolitis. We present our early experience with single stage transanal pull through in neonates and its feasibility with respect to peri-operative, post-operative course and early outcome
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