Short Term and Long term Outcome of Single-Stage Trans-anal Pull Through for Hirschsprung's Disease in Neonates and Infants

Abstract

Purpose: Hirschsprungs disease is common cause of intestinal obstruction in neonate and trans-anal pull through has drastically changed the treatment of Hirschsprungs disease. The aim of this study was to evaluate the short and long-term outcome of single-stage trans-anal pull through in neonates and infants. Material and methods: It was a prospective study of new-born’s and young infants with features of Hirschsprungs disease. Patients with weight more than 3 kg, transition zone at recto sigmoid and distal sigmoid region were included in the study. Patients with more dilated proximal colon, bowel obstruction not responding to washes and long segment Hirschsprungs disease were excluded from the study. Single-stage trans-anal pull through was done in all cases and short term variables include wound infection, leak, peri-anal excoriation and long term outcome variables included continence, constipation, stricture, enterocolitis and need of redo pull-through procedure were evaluated. Results: 24 patients were included in the study. There were 15 males and 9 females. Age of the patients ranged from 26 days to 4.5 months with mean age of 1.3 months. Weight of the patients ranged from 3 kg to 5.3 kg with mean weight of 4.8 kg. Wound infection and perianal excoriation was seen in 8.3% and 45.8% respectively. Enterocolitis, stricture, constipation and minor soiling were seen in 12.5%, 4.2%, 8.3% and 12.5% respectively. Follow-up period ranged from 10 to 120 months. Conclusion: Trans-anal pull through is feasible and safe option with excellent results in neonates and infants with short segment Hirschsprungs disease.