A decade of experience with the primary pull-through for hirschsprung disease in the newborn period: a multicenter analysis of outcomes.
OBJECTIVE
To determine whether use of a primary pull-through would result in equivalent perioperative and long-term complications compared with the two-stage approach.


BACKGROUND
During the past decade, the authors have advanced the use of a primary pull-through for Hirschsprung disease in the newborn, and preliminary results have suggested excellent outcomes.


METHODS
From May 1989 through September 1999, 78 infants underwent a primary endorectal pull-through (ERPT) procedure at four pediatric surgical sites. Data were collected from medical records and a parental telephone interview (if the child was older than 3 years) to assess stooling patterns. A similar group of patients treated in a two-stage fashion served as a historical control.


RESULTS
Mean age at the time of ERPT was 17.8 days of life. Comparing primary ERPT with a two-stage approach showed a trend toward a higher incidence of enterocolitis in the primary ERPT group compared with those with a two-stage approach (42.0% vs. 22.0%). Other complications were either lower in the primary ERPT group or similar, including rate of soiling and development of a bowel obstruction. Median number of stools per day was two at a mean follow-up of 4.1 +/- 2.5 years, with 83% having three or fewer stools per day.


CONCLUSIONS
Performance of a primary ERPT for Hirschsprung disease in the newborn is an excellent option. Results were comparable to those of the two-stage procedure. The greater incidence of enterocolitis appears to be due to a lower threshold in diagnosing enterocolitis in more recent years.
Teitelbaum
D H
DH
Department of Surgery, Section of Pediatric Surgery, the University of Michigan Medical Center and the C.S. Mott Children's Hospital, Ann Arbor, Michigan 48109, USA. dttlbm@umich.edu
Cilley
R E
RE
Sherman
N J
NJ
Bliss
D
D
Uitvlugt
N D
ND
Renaud
E J
EJ
Kirstioglu
I
I
Bengston
T
T
Coran
A G
AG
D002675:Child, Preschool; D005242:Fecal Incontinence / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006627:Hirschsprung Disease / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011183:Postoperative Complications / Q000209:etiology*; D012086:Reoperation; D016896:Treatment Outcome