Swenson revisited: a one-stage, transanal pull-through procedure for Hirschsprung's disease.

BACKGROUND

Hirschsprung's disease is a common cause of neonatal intestinal obstruction. A variety of operations have been used to treat this neurogenic form of bowel obstruction. This report describes an experience with a 1-stage abdominal and transanal pull-through operation in 15 patients with rectosigmoid disease.

METHODS

Fifteen infants with Hirschsprung's disease included 11 boys and 4 girls. Median age at diagnosis was 3 days, and median age of operation was 30 days. Diagnosis was confirmed by rectal biopsy. Biopsies to confirm the transition zone were performed intraabdominally through a left lower quadrant incision. A Swenson pull-through was performed via transanal dissection.

RESULTS

There were no instances of anastomotic leaks, wound infections or postoperative bowel obstructions. All patients survived. Two had postoperative enterocolitis. Twelve of 15 patients did well and had 2-3 bowel motions per day. One with Down's syndrome had enterocolitis and required a colostomy. Two were lost to follow up.

CONCLUSIONS

A one-stage transanal pull-through procedure in infancy is a safe alternative to staged procedures for Hirschsprung's disease.