Système gastro-intestinal et digestif

Abstrait

Primary Transanal Swenson’s Pull through in Hirschsprung’s Disease in SRHF, Mizoram, India

Vanlalhlua Chawngthu and John Lalliandinga

Purpose: The authors describe their experience of primary transanal Swenson’s operation and its short and intermediate term outcome in neonates, infants and children.
Methods: Twenty four patients with rectosigmoid HD (Hirschsprung’s Disease) underwent single-stage transanal Swenson’s procedure. The contrast enema finding with definite transition zone was relied upon for diagnosis. Full thickness rectal dissection was done starting from 0.5-1 cm above the dentate line. The mobilized colon was resected about 5 cm or more above the transition zone. Full thickness colo-anal anastomosis was then performed.
Results: There were 21 male and 3 female patients and the ages of the patients ranged from 4 days to 3 yrs. The mean length of the resected colon was 19.54 ± 9.85 cm. The anatomical transition zone correlated with the pathological transition zone in all the cases. The mean follow up period was 8.28 ± 3.9 months. Two patients had post-operative enterocolitis, and one patient had stricture of the anastomosis. Two patients expired during the follow up period, one due to sepsis and the other due to community acquired pneumonia. One patient continued to have occasional fecal soiling and one patient developed perianal fistula for which diverting colostomy was done. Two patients had ongoing occasional constipation. None of the patients had voiding disturbances or incontinence.
Conclusion: Primary trans-anal Swenson’s pull through is a safe and viable alternative technique for patients with rectosigmoid HD. The procedure is feasible even in neonates and in upper sigmoid colon HD. A long term study is required to determine the incidences of recurrent enterocolitis, gas bloating as well as to assess sexual and urinary functions as the patients grow up.