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Initial experience with one-stage endorectal pull-through procedures for Hirschsprung's disease
E D Skarsgard1, R A Superina, B Shandling
1Department of Surgery, Hospital for Sick Children, M5G 1X8, Toronto, Ontario, Canada.
Pediatric Surgery International
|September 24, 2013
Summary
Single-stage endorectal pull-through (ERPT) for Hirschsprung
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Medical Device Technology
Background:
- Hirschsprung's disease (HD) is a congenital condition characterized by the absence of ganglion cells in the distal bowel, leading to functional obstruction.
- Traditional management often involves a two-stage approach with initial colostomy followed by a pull-through procedure.
- Single-stage endorectal pull-through (ERPT) without colostomy aims to simplify treatment and potentially reduce complications.
Purpose of the Study:
- To evaluate the safety and efficacy of one-stage ERPT for Hirschsprung's disease.
- To compare outcomes of single-stage ERPT with a historical cohort undergoing a two-stage procedure (colostomy followed by ERPT).
Main Methods:
- Retrospective comparison of 7 patients undergoing single-stage ERPT with 20 patients who had a prior colostomy.
- Exclusion criteria for single-stage ERPT included early bowel obstruction, enterocolitis, perforation, massive distension, long-segment disease, or severe anomalies.
- Data collected included patient demographics, presentation age, surgical details, hospitalization duration, and postoperative complications.
Main Results:
- Single-stage ERPT patients presented earlier (median 16 days) and underwent surgery at a younger age (median 4 months) with shorter hospitalization (9 days).
- Complications in the single-stage group (29%) included anastomotic stricture and recurrent enterocolitis, both managed non-operatively.
- The two-stage group had a higher incidence of complications requiring reoperation after initial colostomy (20%) and ERPT (25%), including one death.
Conclusions:
- One-stage ERPT can be safely performed in infants with rectosigmoid Hirschsprung's disease, including those under 3 months.
- This approach reduces total hospitalization duration and avoids complications associated with colostomy.
- Long-term functional outcomes appear comparable to the two-stage approach.
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