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Posterior sagittal approach in complicated Swenson's pull-through.

O A Sowande¹, O Adejuyigbe

¹Department of Surgery, Pediatric Surgery Unit, Obafemi Awolowo University Teaching Hospital, PMB 5538, Ile Ife, Osun State, Nigeria.

Journal of Indian Association of Pediatric Surgeons

|February 24, 2010

Summary

The posterior sagittal approach offers a safe and effective method for treating complications following Swenson

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Area of Science:

Pediatric Surgery
Colorectal Surgery
Surgical Complication Management

Background:

Hirschsprung's disease is commonly treated with Swenson's pull-through procedure.
Pelvic fibrosis following Swenson's pull-through complicates revision surgeries.
Alternative surgical approaches are needed for managing these challenging cases.

Observation:

This study retrospectively reviewed four pediatric patients with post-Swenson pull-through complications.
Complications included rectovaginal fistula, rectourethral fistula, high trans-sphincteric fistula-in-ano, and anastomotic disruption.
Patients' ages ranged from 10 months to 15 years.

Findings:

All four patients were successfully treated using the posterior sagittal trans-sphincteric approach.

Keywords:

Complications Swenson pull-through posterior sagittal approach

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One patient required a second application of the technique without significant adverse events.

Functional outcomes, assessed by Kelly score, were favorable (4-6) in older children.

Implications:

The posterior sagittal approach is a viable and safe option for managing complex post-Swenson pull-through complications.
This technique may reduce morbidity associated with treating these difficult surgical sequelae.
Further research could explore long-term outcomes and patient-reported quality of life.