Primary Swenson's pull-through in children with chronic constipation: a preliminary report

Area of Science:

• Pediatric Surgery
• Gastroenterology
• Colorectal Surgery

Background:

• Hirschsprung's disease in children often presents with chronic constipation and significant fecal loading.
• Discrepancies in resected end diameters complicate primary pull-through procedures in these patients.

Purpose of the Study:

• To evaluate the efficacy of pre-operative bowel preparation using saline enema and oral castor oil in children with Hirschsprung's disease undergoing primary pull-through surgery.

Main Methods:

• Four pediatric patients with Hirschsprung's disease and chronic constipation received saline enemas and oral castor oil for three weeks pre- and post-operatively.
• Intravenous antibiotics (Cefuroxime or Ceftriaxone plus Metronidazole) were administered.
• Resection levels were standardized proximal to the most contractile colon segment near the transition zone.

Main Results:

• All four patients (aged 5 months to 11 years) with rectosigmoid or descending colon aganglionosis underwent successful primary pull-through.
• Post-operative complications included one case each of anastomotic stenosis, mild enterocolitis, and peri-anal excoriation.
• Patients achieved regular bowel movements (2-4 daily) within one month.

Conclusions:

• Pre-operative bowel preparation with saline enema and oral castor oil appears to facilitate successful primary pull-through procedures in chronically constipated children with Hirschsprung's disease.
• Further prospective studies are warranted to confirm these preliminary findings.