Primary Swenson pull-through compared with multiple-stage pull-through in the neonate.
BACKGROUND
In Hirschsprung's disease, the trend has been for earlier performance of definitive surgery. In our institution, primary Swenson pull-through has become the preferred procedure.


METHODS
Retrospective review of the patients treated for Hirschsprung's disease from January 1988 through March 1998 was performed. Sixty-five patients were identified. Median values, analysis of variance and x2 were used for comparisons.


RESULTS
The multiple-stage group (M, n = 47) was similar to the primary group (P, n = 18) for gestational age (40 v 39 weeks), time to meconium passage (37.9 v 35.5 hours), and age at diagnosis (median, M 27 vP 3.5 days). Age (median, M 268 vP 5 days) and weight (mean, M 9.4 v P 3.7 kg; P < .001) at pull-through were lower in the primary group. Length of stay (LOS) was lower in the primary group (mean, M 40.8 vP 20.3 days; P < .05). Operating time for pull-through was decreased in P (mean, M 305.2 v P 272.2 minutes; P = .02). Total complications were lower in the primary group (P = .03), with no differences in mortality or enterocolitis rates.


CONCLUSIONS
At our institution there were no increases in total complications or enterocolitis in the group undergoing primary Swenson. Primary pull-through is a viable option for the treatment of Hirschsprung's disease.
Santos
M C
MC
East Tennessee State University, James H. Quillen College of Medicine, Department of Surgery, Johnson City 37614-0575, USA.
Giacomantonio
J M
JM
Lau
H Y
HY
D000704:Analysis of Variance; D016009:Chi-Square Distribution; D003106:Colon / Q000601:surgery; D013505:Digestive System Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006627:Hirschsprung Disease / Q000601:surgery*; D006801:Humans; D007231:Infant, Newborn; D007902:Length of Stay; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D012189:Retrospective Studies; D016896:Treatment Outcome