Background: Traditional surgical management of Hirschsprung's disease consists of a three-stage approach including proximal colostomy, definitive pull-through resection at one year of age and closure of the stoma shortly after the pull-through. At our institution, patients with this disorder have been operated with a one-stage transanal technique without laparotomy and colostomy since 2001. The early results of this procedure are presented in the article.
Patients and methods: Complications and postoperative bowel function have been recorded after the introduction of the one-stage transanal technique.
Results: Transanal pull-through was intended in 20 children. Laparotomy (5 patients) and laparoscopy (1 patient) were done in 6 of the children due to technical reasons. Median weight at operation was five kg (3.5-25 kg), and a median of 25 cm of bowel (9-36 cm) were resected transanally. There were no perioperative complications. Postoperative complications included stricture (3 patients), perianal excoriations (2 patients) and severe constipation (1 patient). Short term follow up shows similar bowel habits as after laparotomy procedures.
Interpretation: Early results show that primary transanal pull-through in Hirschsprung's disease patients with aganglionosis to descending colon is safe. It is beneficial to avoid a colostomy and probably laparotomy.