# Surgical decision making in late-presenting Hirschsprung's disease: direct pull-though or stoma first

## TL;DR

This study compares one-stage and staged surgical approaches for treating Hirschsprung's disease in older children, finding both methods safe.

## Contribution

The study evaluates surgical outcomes in late-presenting Hirschsprung's disease using direct pull-through or stoma-first approaches.

## Key findings

- Staged and single-staged procedures showed similar safety in older Hirschsprung's disease patients.
- Postoperative complications included stenosis, enterocolitis, and stomal prolapse.
- Rectal irrigation failed in half the cases, necessitating colostomy or ileostomy.

## Abstract

To evaluate the use of staged vs. one-stage surgical management for Hirschsprung's disease (HSD) in older children.

In total, 30 patients were diagnosed with HSD and all cases were confirmed by rectal biopsy. For treatment, rectal irrigation was carried out for two months to achieve colonic decompression; treatment failure occurred in 15 cases due to decompressed colons. In these cases, colostomy or ileostomy were carried out according to the distal or proximal site of the transitional zone to the transverse colon. After two months, eight cases of Laparoscopic Duhamel and seven cases of laparoscopic-aided Swenson were performed.

An anal dilation program was done three weeks after pull-through. Postoperatively, there were three cases of Swenson cases stenosis and two cases of enterocolitis that responded to conservative treatment and one case of fecal incontinence. In Duhamel cases, we had three cases of constipation and three cases of enterocolitis, with no anastomotic leak cases. Four cases of stomal prolapse and skin excoriation occurred.

Both staged and single-staged procedures are safe options for the management of hirshspung's disease in older children.