Abstract
Purpose: Although the importance of preoperative colonic decompression for Hirschsprung’s disease (HD) is well recognized, no definitive procedure has yet been established. We herein report our procedure for carrying out the preoperative management of HD.
Methods: Nine patients diagnosed as having HD by contrast enema were managed by preoperative irrigation twice a day and continuous drainage through double transanal tubes made of polyvinyl chloride from January 2010 to May 2015.
Results: There were 2 rectal aganglionosis patients, 5 rectosigmoid aganglionosis patients, 1 long-segment aganglionosis patient, and 1 total colon aganglionosis patient. We fixed the transanal tubes from the sigmoid descending colon junction to the cecum as the extent of the aganglionic segment. The median age at transanal tube fixation was 3 days (range, 1‒130 days), the median length of preoperative tubing was 21 days (range, 17‒88 days), and the median age of primary pull-through was 26 days (range, 20‒301 days). During the tubing period, all patients could be fed by peroral intake. We were able to manage the patient with total colon aganglionosis for 20 days before ileostomy until the diagnosis of HD was confirmed histopathologically, and we successfully performed primary pull-through on the other 8 patients. There were no complications associated with tube insertion, and no worsening of colitis occurred.
Conclusions: We are able to effectively and rapidly perform colonic irrigation with an even intracolonic pressure using our procedure with double transanal tubes. This form of management is therefore considered to be safe and useful for HD patients.
