[Results of one stage transanal resection of large bowel in hirschsprung's disease]

ABSTRACT

Hirschspnmg's disease is a developmental disorder of the enteric nervous system, characterized by functional obstruction. Absence of ganglion cells in the distal colon resulting in a functional obstruction. The aim of this study was to evaluate the results and complications of one-stage transanal endorectal pull-through [OTEPT] in the management of patients with Hirschsprung's disease. A total of 40 children [31 boys and 9 girls] aged 3 days to 60 months underwent OTEPT procedure over a period of two-years at Dr. Sheikh pediatric Hospital. This study was approved by the local committee of Medical Ethics. Median follow up period was 9.10 months [range, 3 to 33 months]. Mean operation time recorded 101.60 mins [range, 25 to 270 minutes]. Hirschsprung's disease developed conventional in 55% [short segment in 30%], Ultra-short in 32.5% and long segment in 12.5%. Mean length of resected bowel measured 17.31 cm, 2 patients underwent laparatomy because of extension of aganglionic segment beyond the sigmoid colon. Mean NPO time and need to rectal tube after the operation were 4.35 and 4.41 days, respectively. 8 patients required urinary catheters after the operation with the mean remaining time of 3.30 days, 20% needed ICU care after surgery and mean hospital stay was 5.76 days. Post-operative complications included entrocolitis [n=2] and abdominal distension [n=1]. One patient expired due to non surgical reason [heart failure]. OTEPT procedure is a safe method with low incidence of postoperative complications. In Hirschsprung's disease confined to the rectosigmoid region, the hazard and morbidities associated with laparatomy and colostomy are avoided with this technique