2003 Volume 39 Issue 1 Pages 47-52
Purpose The purpose of this clinical trial was to evaluate the usefulness of preoperative decompression and irrigation through a transanal tube in order to perform a one-stage pull-through procedure for Hirschsprung's disease (HD). Methods Over the past three years, 16 patients with HD diagnosed in the neonatal period were managed with preoperative decompression and irrigation through a transanal tube. The mean age and weight on admission was 64 days, and 30 kg, respectively. The extent of aganglionic segment varied as follows rectum in six patients, rectosigmoid in five patients, sigmoid colon in four patients, and transverse colon in one patient An 8 or 10F tube was introduced into the proximal dilated bowel through the anus, and irrigation with normal saline was carried out twice a day. Corrective pull-through operation was performed using a modified Duhamel's procedure through a small transverse supra-pubic incision. Results Decompression using the tube was easy and highly effective, and abdominal distention rapidly disappeared in all patients. The mean length of preoperative tubing was 54 days without any complications. The mean age and weight at operation were 705 days and 49 kg, respectively. Major postoperative complications were enterocolitis in two patients, and bowel obstruction in one patient. The mean postoperative stay was 42 days. While the patients' ages now range from 6 mo to 3 yr, three patients have normal bowel habits. Cosmetic results were reported as satisfactory by their parents. Conclusion The one-stage pull-through procedure for HD with this management could be performed safely without colostomy Since the primary transanal pull-through procedure will be used as a main technique for HD in the near future, preoperative decompression and irrigation through the transanal tube will be useful.
