Iraqi Postgraduate Medical Journal

Abstract

ABSTRACT:
BACKGROUND:
Hirschsprung’s disease (HD) is a common cause of intestinal obstruction in children. Definitive treatments consist of excision of the aganglionic segment and anastomosing the normal colon to the anal remnant by trans anal swenson approach.
OBJECTIVE:
The purpose of this study was to evaluate the feasibility and safety of TESPT technique for management of HD & its results.
PATIENTS AND METHODS:
It is aprospctive study ,where 33children (30 boys and 3 girls) with proven HD were treated at our pediatric surgical department between April 2009 and November 2013. Their ages ranged from 6 months to 8 years. The case files were evaluated for age at operation, associated congenital anomalies, operative time, intraoperative blood loss and blood transfusion, time to resume oral feeding, hospital stay, postoperative complications, and postoperative continence state. The median follow-up period was 12 months(range 3 to 21 months) . The diagnosis was confirmed by barium enema &/or by partial thickness rectal biopsy for histopathological examination for all cases. Most patients had a well-defined transition zone at or distal to midsigmoid colon on preoperative contrast enema
RESULTS:
Male to female ratio was 10:1. one patient had positive family history for Hirschsprung's disease . The definitive TESPT was done in the patients at a median age of 10 months( range 6 months - 8 years). Seven patients had primary pull-through without colostomy.The median operative time was 120minutes (range 90-150 minutes). The length of the resected bowel varied between 20cm and 42cm. The length of hospital stay was 3 to 5 days. The time to resume oral feeding was ranging from 24-48 hours. There are 4 patients with recurrence of obstructive symptoms (retained piece) . 3 patients(9.09%) required readmission for treatment of enterocolitis. Postoperative adhesive intestinal obstruction occurred in 1patient (3.03%). Soiling occurred in 3 patient out of 33pts.(9.09%). Perianal excoriation occurring in 7 patients(21.21%) ,1 patient(3.03%) was died.
CONCLUSION:
Tespt technique is both feasible and safe technique in properly selected children with rectosigmoid HD in all ages. The technique is easily learned and is associated with excellent clinical results.