A survey of current practices in management of Hirschsprung's disease in Nigeria.
BACKGROUND
Although there are several modalities of treatment for Hirschsprung's disease (HD), there are presently no clear guidelines on treatment of the condition by paediatric surgeons in Nigeria. This survey determines the current approach to treatment among Nigerian paediatric surgeons and should help in establishing a consensus and guidelines for care in this and similar setting.


METHODS
An online questionnaire was designed using survey Monkey ® to determine current clinical and operative management of patients with HD by consultant paediatric surgeons practicing in the Nigeria. The paediatric surgeons were notified by E-mail, which included a link to the survey on survey Monkey ® . The survey was also administered at the 12 th annual meeting of Association of Paediatric Surgeons of Nigeria in September, 2013, to capture those who did not complete the online survey. Thirty-one paediatric surgeons from 21 different tertiary paediatric surgery centres completed the survey.


RESULTS
Sixteen (52%) respondents see up to 20% of their patients with HD in the neonatal period. Twenty-six (84%) respondents do routine barium enema. Twenty six (84%) respondents do full thickness rectal biopsy under general anaesthesia (GA). There was no consistency in operative techniques, with transabominal Swenson's operation being practiced by 17 (57%) respondents and 11 (37%) transanal endorectal pull through. 14 (45%) do pull through at any age. 12 (39%) respondents do more than half of their patient as primary pull through.


CONCLUSIONS
Full thickness rectal biopsy under GA is still the vogue with variations in the surgical technique for management of Hirshsprung's disease in Nigeria. Primary pull through procedures is becoming increasingly popular. There's a need for Paediatric Surgeons in Nigeria to come up with a guideline on management of HD, to guide trainees and other surgeons in the care of these patients.
Department of Surgery, Division of Paediatric Surgery, University of Ilorin, University of Ilorin Teaching Hospital, Ilorin, Nigeria.
Abdulrasheed A
AA
Nasir
Emmanuel A
EA
Ameh
D001003:Anal Canal / Q000503:physiopathology / Q000601:surgery; D001291:Attitude of Health Personnel; D001707:Biopsy, Needle; D003906:Developing Countries; D013505:Digestive System Surgical Procedures / Q000379:methods*; D005260:Female; D019538:Health Care Surveys; D006627:Hirschsprung Disease / Q000453:epidemiology / Q000473:pathology* / Q000601:surgery*; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D009549:Nigeria; D010818:Practice Patterns, Physicians' / Q000592:standards* / Q000639:trends; D011379:Prognosis; D018570:Risk Assessment; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D016896:Treatment Outcome