Surgical Sciences Research Society, Zaria and Association of Surgeons of Nigeria
Abstract
Background: In our center, our approach has been to practice the
traditional staged procedure for the treatment of Hirschsprung s
disease. This prospective study was to determine the feasibility of
early neonatal pull through and in infants less than 4 months.
Methods: 5 consecutive patients with Hirschsprung s disease under
4 months of age were recruited in to the study. Full thickness rectal
biopsy confirmed the diagnosis in all the patients. A primary
definitive Swenson s pull through was using standard technique
with intraoperative frozen section when available. Perioperative
Ceftriaxone and metronidazole was administered preoperatively. A rectal
tube made from a 2cc syringe was left in situ for 5-7 days after the
operation Results Four of the patients were seen within the neonatal
period and a patient presented at 13 weeks, the male to female ratio is
4:1. The mean weight at admission is 3.20kg while the mean weight at
surgery was 3.75kg. Intra-operative frozen section revealed that two
patients had aganglionosis up to the proximal sigmoid colon while 2
other patients had an aganglionosis up to the proximal descending colon
and the distal transverse colon respectively. All the patients were
commenced with oral intake on or before 4th post-operative day. Wound
infection and paralytic ileus occurred in the immediate post operative
period in one patient each while another developed an incisional
hernia. None of these complications was life threatening and were all
managed as required. Bowel opening in the patients range from 2-5 times
daily. Conclusions. Based on this preliminary study it can be
concluded that primary neonatal and early infancy pull through is
feasible and advantageous to the patients. Further prospective works in
this area are needed coupled with improvement in the neonatal care
facilities