[Congenital megacolon in neonates and infants: impact of early, one-stage repair on morbidity and surgical complications].
Hirschsprung's disease (HD) is a major cause of congenital bowel obstruction in children. Classical management includes stoma creation, a pull-through procedure, and restoration of bowel continuity. Colostomy may be also pulled through directly at second operation. Since the first report of a single stage (SS) primary pull-through without colostomy for HD, in 1980, several patients have been treated according to this procedure, even in neonatal period. All of them had a favourable outcome with better compliance of families and less hospital stay. The Authors reviewed the clinical records of 22 patients selected among 36 treated for HD between 1992 and 2000; in all, disease extended to rectum-sigma-descendent; all cases of "total aganglionosis" or "ultra short" cases were excluded. Fifteen patients underwent SS repair: 11 neonates were operated at mean age of 69 days (range 14-172). In four infants diagnosis was made later (mean age 15 +/- 9 months) and SS repair was performed 8 days after (range 4-14). Seven patients underwent multiple stage (MS) repairs for clinical reasons: pull-through of the previous colostomy was performed at mean age of 171 days (range 47-330). A Duhamel procedure with an Endo-GIA linear stapler was performed in all No differences in gestational age or birth weight were found in both groups. Complications were observed only in the MS group (2 related to colostomy, 1 to postoperative adhesions). The Authors conclude that primary SS treatment of HD is safe and effective even in newborn patient, reduce familiar stress and hospital stay. The lower morbidity and complication rates could be explained by the limited bowel manipulation. Accurate histological-hystochemical diagnosis and meticulous preoperative bowel management should be part of the management.
Calisti
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Unità Operativa di Chirurgia Pediatrica, Azienda Ospedaliera S. Camillo, Forlanini, Roma. a.calisti@tiscali.it
Molle
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PH
Vallasciani
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S
D013505:Digestive System Surgical Procedures / Q000009:adverse effects / Q000379:methods; D006627:Hirschsprung Disease / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D013997:Time Factors