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Pearls & pitfalls: Primary Transanal Swenson-like pull-through for late diagnosed Hirschsprung disease
Ubaidullah khan 1, sayed salah ud din 2, abdullah farooq 2, majid khan 2, naseem khan 2, Dima batool 2, Abdul hameed 2, zahir shah 2
1 Lady reading hospital/Farooq hospital Islamabad
2 lady reading hospital
Purpose: In our center we came across with children who presented late with prolong constipation, abdominal distension and no episode of enterocolitis. We present our unique experience with older children in whom the surgical protocol we apply is similar to those who diagnosed at neonatal period. Contrast enema was more helpful in these older children; transition zone was highly reliable to recto-sigmoid in all of our cases.
Methods: A retrospective review was performed (June 2020 to March 2024) to identify those patients who underwent transanal Swenson-like pull-through at older age (> 2 years at presentation), assessing for postoperative stricture, anastomotic leak, fecal continence (above 4years), comparing the contrast study accuracy with biopsy report.
Results: Total 88 patients, 65 males and 23 female, 79 had primary transanal Swenson surgery and 9 had a stoma, done with long safety margin at neonatal period, included in study. The average length of resection was 18 cm ± 12 cm. 40 patients were above 5 years of age, including one 12 years old female patient.
At follow-up all had voluntary bowel movements, with 1 complain of constipation (requiring laxatives), 3 presented with mild symptoms of enterocolitis, treated as outpatient.We have two diversions after primary surgery, both have ileostomy, reason was local leak, long segment and respond well after diversion.
10 patients required dilation and especial with stoma one due to narrowing at anatomises site.
Conclusion: Our data review support the fact that a primary transanal approach is an excellent technique for late diagnosed HD , produces excellent outcomes in term of faecal continence, cosmetic and less financial burdens on families.
In the rare circumstance a late-diagnosed child with HD with huge proximal colonic dilation or malnutrition, a decompressive stoma as a first step is a safer option to help prevent complications.