title: Early outcome of open primary pull through versus staged pull through in Hirschsprung's disease: a single centre experience from Nigeria.
abstract: BACKGROUND
  The treatment of Hirschsprung's disease has followed a trend from 2 or 3-staged pull-through (SPT) procedures to a single stage primary pull-through (PPT) procedure and from open surgery to laparoscopy-assisted, and trans-anal pull through procedures. The (PPT) procedure has the advantage of avoiding a stoma and its complications.
  
  
  OBJECTIVE
  This study compares the outcomes in open PPT and SPT in our centre.
  
  
  METHODS
  Retrospective observational study at a single centre from Nigeria over a 4year period.
  
  
  RESULTS
  Of 46 patients with Hirschsprung's disease, 29 patients had pull-through procedures during the study period; 19 had SPT and 10 had PPT. There were 21 boys and 8 girls (M:F = 2.6:1). Five (17.1%) were diagnosed in the neonatal period and median age at surgery was 30 months (1 month - 31 yrs). The mean length of hospital stay was 30 days (+/- 7) in the SPT group while it was 16 days (+/- 3) in the PPT group, p < 0.05. Colostomy morbidity such as prolapse and skin excoriation showed statistical significant difference compared to other complications associated with pull-through (p < 0.05); however morbidity from pull-through procedures alone were similar. There was no statistically significant difference in post operative bowel habit irrespective of type of pull through operation performed (p > 0.05). Patients were followed up for between 3 months and 36 months. Two patients died giving a mortality rate of 6.7% overall.
  
  
  CONCLUSIONS
  PPT significantly reduced both hospital stay and colostomy complications compared to SPT.
authors.affiliation: Paediatric Surgery Unit, Department of Surgery, College of Medicine, University of Lagos, PMB 12003, Idi Araba, Lagos. adesojiademuyiwa@yahoo.co.uk
authors.forename: Adesoji O
authors.initials: AO
authors.lastname: Ademuyiwa
authors.affiliation: Paediatric Surgery Unit, Department of Surgery, College of Medicine, University of Lagos, PMB 12003, Idi Araba, Lagos.
authors.forename: Chris O
authors.initials: CO
authors.lastname: Bode
authors.affiliation: Paediatric Surgery Unit, Department of Surgery, College of Medicine, University of Lagos, PMB 12003, Idi Araba, Lagos.
authors.forename: Hestia O
authors.initials: HO
authors.lastname: Idiodi-Thomas
authors.affiliation: Paediatric Surgery Unit, Department of Surgery, College of Medicine, University of Lagos, PMB 12003, Idi Araba, Lagos.
authors.forename: Olumide A
authors.initials: OA
authors.lastname: Elebute
mesh_terms: D000293:Adolescent; D000328:Adult; D001003:Anal Canal / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D005260:Female; D006627:Hirschsprung Disease / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D010535:Laparoscopy; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D009549:Nigeria; D012189:Retrospective Studies; D016896:Treatment Outcome