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Primary corrective operation without decompression in infants less thn three months of age with Hirschsprung's
Insights
This study shows that performing the Swenson
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Neonatal Care
Background:
- Hirschsprung's disease is a congenital condition affecting the large intestine.
- Historically, treatment involved colostomy followed by a definitive surgical procedure.
Purpose of the Study:
- To evaluate the evolution of surgical management for Hirschsprung's disease.
- To assess the impact of early surgical intervention and improved supportive care.
Main Methods:
- Retrospective analysis of 155 infants treated between 1965 and 1980.
- Comparison of outcomes based on surgical timing and the use of colostomy.
Main Results:
- Early Swenson's procedure (before 3 months) without colostomy yielded excellent results.
- Mortality decreased significantly, and functional outcomes improved with earlier intervention.
Conclusions:
- Advocating for early surgical correction of Hirschsprung's disease in selected cases.
- Improved nursing and total parenteral nutrition facilitate earlier definitive surgery, reducing complications.
Abstract:
From Jan 1, 1965 to Nov 1, 1980, 155 infants with Hirschsprung's disease have been treated. All had confirmed aganglionosis at multiple rectal biopsies. From 1965 to 1969, 54 patients underwent a Swenson's procedure at an age ranging from 12 to 18 months after a preliminary colostomy. 13 patients died between colostomy and definitive operation. From 1969 to 1977, the delay in performing corrective operation after colostomy was shortened and the definitive procedure was done between 6 and 11 months of age in 69 patients. No fatality was observed but in 9 cases a perianal dermatitis lowered the quality of functional results. From 1977 to Nov 1, 1980, progress in immediate nursing and total parenteral nutrition made colostomy unnecessary in 19 neonates and infants with severe Hirschsprung's disease. The definitive surgical procedure (mainly Swenson's) was performed before 3 months of age. The postoperative results were excellent. After more than 4 years of follow-up for the first cases, the good secondary results, the quality o defecation, and the shortening of total hospital time, allow us to advocate this method in selected cases.