Staged pull-through for rectosigmoid Hirschsprung's disease is not safer than primary pull-through

Area of Science:

• Pediatric Surgery
• Gastroenterology
• Clinical Outcomes

Background:

• Hirschsprung's disease treatment traditionally involves staged pull-through (PT) surgery.
• Primary PT has emerged as an alternative with variable reported complication rates.

Purpose of the Study:

• To compare complication rates of staged versus primary PT for rectosigmoid Hirschsprung's disease.
• To evaluate the safety of primary PT in infants and compare surgical techniques.

Main Methods:

• Retrospective review of 116 patients with Hirschsprung's disease treated between 1989-1995.
• Analysis of complications in 87 patients with rectosigmoid aganglionosis based on surgical approach (staged vs. primary), year, and age at primary PT.

Main Results:

• No significant difference in complication rates between staged and primary PT.
• Primary PT demonstrated similar complication rates in infants and older children.
• Primary Swenson PT had a higher complication rate (100%) compared to primary Duhamel PT (20%).

Conclusions:

• Staged PT offers no safety advantage over primary PT for rectosigmoid Hirschsprung's disease.
• Primary PT is a safe and viable option for infants with rectosigmoid Hirschsprung's disease.
• Primary Duhamel PT is preferable to primary Swenson PT due to lower complication rates.