Soave procedure for infants with Hirschsprung's disease

Area of Science:

• Pediatric Surgery
• Gastroenterology
• Surgical Innovation

Background:

• Hirschsprung's disease (H.D.) traditionally requires a two-stage surgical approach with preliminary colostomy.
• The transanal Soave procedure offers a single-stage alternative, avoiding abdominal incisions and preliminary colostomy.

Purpose of the Study:

• To report the initial experience with the single-stage transanal Soave pull-through procedure for Hirschsprung's disease in India.
• To evaluate the feasibility and early outcomes of this minimally invasive technique in infants.

Main Methods:

• Four infants underwent a transanal pull-through procedure for Hirschsprung's disease.
• The technique involved rectal mucosectomy, circumferential division of the muscular sleeve, and intraoperative confirmation of ganglion cells via frozen section.

Main Results:

• The average operative time was 160 minutes with an average bowel resection length of 22 cm.
• No postoperative complications were observed, with patients discharged on the seventh postoperative day.
• Median follow-up of 5 months showed 2-4 stools per day without soiling or constipation.

Conclusions:

• The single-stage transanal Soave pull-through is a successful and potentially advantageous approach for Hirschsprung's disease in infants.
• Advantages include lower cost, reduced risk to pelvic structures, absence of abdominal incisions, and decreased adhesion formation.
• Early functional results indicate prompt bowel function recovery without significant complications.