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Management of Hirschsprung's disease: curative surgery before 3 months of age
M Carcassonne1, J M Guys, G Morrison-Lacombe
1Clinique Chirurgicale Infantile et Orthopédie, Marseille, France.
Insights
Primary surgery for Hirschsprung
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Neonatology
Background:
- Hirschsprung's disease (HD) is a congenital condition affecting the large intestine.
- Early diagnosis and surgical intervention are crucial for infants.
- Optimal timing and approach for primary corrective surgery in young infants remain debated.
Purpose of the Study:
- To evaluate the safety and efficacy of primary corrective surgery for Hirschsprung's disease in infants under 3 months.
- To assess outcomes without routine colostomy in this age group.
Main Methods:
- Retrospective analysis of 32 infants younger than 3 months undergoing curative surgery for HD between 1977 and 1986.
- Surgical procedures included Swenson's, Duhamel's, and Soave's.
- Preoperative management involved enemas and, in severe cases, total parenteral nutrition; colostomy was reserved for complications.
Main Results:
- No mortality was observed in the study cohort.
- Overall postoperative morbidity was 15.6% (5/32), including anastomotic leak, stenosis, volvulus, and recurrent enterocolitis.
- The majority of patients achieved definitive cure without routine colostomy.
Conclusions:
- Primary corrective surgery for Hirschsprung's disease is feasible and safe in infants under 3 months.
- Routine decompression via colostomy is not necessary in this population.
- Early surgical intervention without prior decompression can lead to favorable outcomes.
Abstract:
Curative surgery of Hirschsprung's disease (HD) was performed in 32 infants younger than 3 months of age from January 1, 1977, December 31, 1986. There were 24 males, seven of whom presented with total colonic aganglionosis. Preoperative relief of obstruction was carried out by only enemas in 25 patients (81%), with addition of total parenteral nutrition of 8 to 27 days in case of severe enterocolitis. Colostomy was never performed as a routine procedure. Preoperative morbidity occurred in three cases: one enterocolitis and two sigmoid performations that were successfully treated by colostomy. Weight at operation ranged from 3.3 to 6.0 kg (mean, 4.9 kg). Swenson's (25), Duhamel's (5), and Soave's procedures (2) were performed. There was no mortality. Follow-up varied from 2 to 10 years. Postoperative morbidity occurred in five patients (one anastomotic leak, two stenosis, one volvulus, and one recurrent enterocolitis). All other patients are considered as definitively cured. Comparison with data in the literature permits one to advocate primary corrective treatment of HD without decompression in infants less than 3 months of age.