Outcome of trans-anal posterior anorectal myectomy for the ultrashort segment Hirschsprung's disease--Benin City experience in five years.

OBJECTIVE

The conventional treatment of Hirschsprung's disease involves colostomy creation, excision of aganglionic segment, pull through using normally ganglionated proximal bowel segment and colostomy closure. The ultrashort segment variety is treated with posterior anorectal myectomy which requires no prior colostomy creation. This study sought to evaluate the benefits and outcomes of the procedure in a tertiary hospital in Nigeria.

PATIENTS AND

METHODS

All children diagnosed with ultrashort segment Hirschsprung's disease between January 2003 and December 2007 at the University of Benin Teaching Hospital, Benin City, were prospectively studied.

RESULTS

Of 64 children managed with Hirschsprung's disease in five years, 11 (17.2%) were diagnosed with ultrashort segment variety and had posterior anorectal myectomy without prior colostomy. They comprised 7 males and 4 females with male/female ratio 1.8:1 and were aged between 1 month and 9 years (mean 1.5 +/- 0.8 years). The procedure was well tolerated and gave satisfactory results in all the patients as no wound infection or any life threatening morbidity and mortality was recorded. Postoperative pain which responded to paracetamol in the majority of children was statistically significant in older compared to younger patients (P<0.0001). Oral feeds were commenced and tolerated earlier, length of hospitalisation was shorter and no incontinence was recorded unlike the conventional treatment. Also, postoperative nursing care was easier and the single procedure resulted in availability of theatre space for other paediatric operations. All the children did well on 9 months to 4 years follow-up.

CONCLUSION

The procedure was found to be beneficial and effective for ultrashort segment Hirschsprung's disease, and should be employed in this subregion.