Delayed primary colorectostomy after endorectal abdominoperineal pull through for Hirschsprung's disease

ABSTRACT

A personal experience with 40 consecutive patients undergoing 41 delayed primary colo-rectostomy [DPCR] after endorectal abdomino-perineal pull-through [ERAPP] for the treatment of Hirschsprung's disease [H.D.] between 1978 and 1983 is presented. Three patients underwent a rectal myectomy before the [ERAPP]. Twenty-three of 38 patients [58%] had the decompressive preliminary colostomy performed in the first month of life. The ERAPP was done under cover of colostomy in two of 38 patients, the remainder having had their colostomy resected at the time of pull-through. Three patients were recolostomized in the immediate post-DPCR period to permit adequate healing of the pulled-through segment. The DPCR was practised 5 to 7 days after the ERAPP in all patients. One patient had evidence of postoperative hypoganglionosis of the pulled-through colon requiring a redo of the ERAPP. Two patients developed postoperative enterocolitis which led to the death of one infant six weeks postoperatively. The functional results indicate complete fecal continence for 30 patients, i.e. a rate of 76%, within two years after operation. This rate Increased to 90% during the subsequent two years. The variability in the age at which complete fecal continence was acquired is noted