Early and Late Complications Following Surgical Repair of Hirschsprung's Disease in Pediatric Patients

Abstract

Background: Early,. diagnosis and repair make a better prognosis in Hirschsprung's disease (HD) patients. Two basic approaches, namely single staged and multiple staged pull through are commonly applied to treat such patients. In this study we tried to compare short-term and long-term complications of the two procedures to provide a guide for choosing the safer and more effective approach. Methods: The study involved all the HD cases treated via either of the two common approaches during a seven-year period from 1995 to 2002 in Isfahan, Iran. Fourteen patients underwent single-staged repair (SS) but the remaining 48 were treated via a multiple-staged approach (MS). Short-term and long-term complications together with patients' defecation patterns were compared between the two groups. Results: Early wound infection was significantly more prevalent among MS group (9 (19%) in MS groups vs. 1 (7%) in SS group; P < 0.05). Intestinal obstruction, severe enterocolitis, and anastomotic stricture were considerably lower in SS repair than in MS procedure. Defecation patterns in both groups were comparable. Compared with the MS approach, the number of hospital admissions and total length of stay were significantly lower in the SS group. Conclusions: Although restoration of normal function is achieved with both procedures, early and late complications, number of admissions and the total length of hospital stay are considerably lower with the SS pull through. Therefore, with an earlier diagnosis, SS repair can be an improved strategy, which will bring a better prognosis for HD patients.
Keywords: Hirschsprung's disease, Intestinal aganglionosis, Congenital megacolon, Primary endorectal pull
through