THE RESULTS OF TWO-STAGE SURGICAL MANAGEMENT OF HIRSCHSPRUNG’S DISEASE IN A 10-YEAR PERIOD

Background-Hirschsprung’s disease has several surgical treatments, including curative surgery which consists of total or subtotal resection of the aganglionic segment followed by a pull-through of the normally innervated intestine. This study intends to assess the aftermath of two-stage endorectal pull-through procedures. Methods-Medical records of 62 patients (46 males, 16 females), who were treated for Hirschsprung’s disease during a 10-year period, were reviewed. Age, sex, extent of aganglionosis, primitive surgical procedure, age at colostomy, age at definitive procedure, number of stages, immediate and late postoperative complications, postoperative causes of death and time of the first postoperative defecation were retrieved in all patients. Results- Results showed that 61 patients had colostomy or ileostomy as the primitive procedure. Two-stage Soave Boley procedure was done in 54 cases; in 32 (52.4%) patients the Soave-Boley procedure was followed by appendectomy and tube cecostomy and in 22 (36%) patients, Soave-Boley pull-through was done without appendectomy and tube cecostomy. The results of the definitive operations were promising in 90.1% of the patients who gained normal defecation. Early complications were met in 9 cases (14.7%) and late complications were present in 14 cases (22.9%). The mortality rate was 4.9% (3 patients); the first patient had sepsis following ileostomy, the second patient suffered from enterocolitis 6 months post-operatively and the third patient died four days after treatment. Conclusions- By eliminating one of the stages in the surgical procedure, superior results with less complications are achieved. This in turn precludes the use of costly staplers. Altogether, the Soave-Boley procedure has proved to be a cost-effective and desirable procedure in comparison to other techniques in the treatment of Hirschsprung’s disease.