A decade of experience with the primary pull-through for hirschsprung disease in the newborn period: a multicenter analysis of outcomes

• Published in: Annals of surgery 2000-09, Vol.232 (3), p.372-380
• Main Authors: Teitelbaum, D H, Cilley, R E, Sherman, N J, Bliss, D, Uitvlugt, N D, Renaud, E J, Kirstioglu, I, Bengston, T, Coran, A G
• Format: Article
• Language: English
• Subjects: Child, Preschool; Fecal Incontinence - etiology; Female; Follow-Up Studies; Hirschsprung Disease - surgery; Humans; Infant; Infant, Newborn; Male; Postoperative Complications - etiology; Reoperation; Scientific Papers; Treatment Outcome
• ISSN: 0003-4932; 1528-1140
• DOI: 10.1097/00000658-200009000-00009

To determine whether use of a primary pull-through would result in equivalent perioperative and long-term complications compared with the two-stage approach. During the past decade, the authors have advanced the use of a primary pull-through for Hirschsprung disease in the newborn, and preliminary results have suggested excellent outcomes. From May 1989 through September 1999, 78 infants underwent a primary endorectal pull-through (ERPT) procedure at four pediatric surgical sites. Data were collected from medical records and a parental telephone interview (if the child was older than 3 years) to assess stooling patterns. A similar group of patients treated in a two-stage fashion served as a historical control. Mean age at the time of ERPT was 17.8 days of life. Comparing primary ERPT with a two-stage approach showed a trend toward a higher incidence of enterocolitis in the primary ERPT group compared with those with a two-stage approach (42.0% vs. 22.0%). Other complications were either lower in the primary ERPT group or similar, including rate of soiling and development of a bowel obstruction. Median number of stools per day was two at a mean follow-up of 4.1 +/- 2.5 years, with 83% having three or fewer stools per day. Performance of a primary ERPT for Hirschsprung disease in the newborn is an excellent option. Results were comparable to those of the two-stage procedure. The greater incidence of enterocolitis appears to be due to a lower threshold in diagnosing enterocolitis in more recent years.