Transcolostomy-site endorectal pullthrough for Hirschsprung’s disease

Abstract

Purpose To present our results for an endorectal pullthrough operation as the second stage for the treatment of Hirschsprung’s disease through the colostomy site.
Materials and methods This study included 13 patients, four girls and nine boys. Their ages ranged from 9 months to 7 years. They presented with a leveling colostomy with a diagnosis of Hirschsprung’s disease. The colostomy was carried out in the neonatal period because of neonatal intestinal obstruction in three patients (one female and two males), in two patients because of recurrent attacks of enterocolitis, and three patients because of the inability of the patient to withstand major surgery. Four patients presented without a clear history of the cause for the colostomy. One patient aged 7 years presented with sigmoid volvulus. All the patients were subjected to a transcolostomy endorectal pullthrough.
Results The operation was completed as described in all patients. The time from colostomy to pullthrough ranged from 3 to 7 months (median 4.7 months). The operation time ranged from 95 to 140 min (median 113 min). All the patients passed stool within 24–48 h. Stool output ranged from two to six stools per day. Optimal wound healing occurred in all patients without wound complications. Postoperative perineal excoriation occurred in four patients. A urinary tract infection developed in one patient. A patient with a history of recurrent attacks of preoperative enterocolitis developed mild enterocolitis 2 weeks after the operation. Adhesive intestinal obstruction occurred in one patient. Recurrence of symptoms occurred in two patients because of stricture at the anastomotic site, one responded to repeated dilatation and the other required internal sphincterotomy.
Conclusion Transcolostomy endorectal pullthrough has the following advantages: it is associated with less pain and a shorter hospitalization than the classic endorectal pullthrough. Wound complications are rare. The cosmetic result is better than the classic Soave operation. It has no specific technique-related complications. Long-term outcome and functional results are good. To our knowledge, this approach has not been described before. 

Keywords: Hirschsprung’s disease, leveling colostomy, pullthrough