A survey of current practices in management of Hirschsprung’s disease in Nigeria

Abstract

Background: Although there are several modalities of treatment for Hirschsprung’s disease (HD), there are presently no clear guidelines on treatment of the condition by paediatric surgeons in Nigeria. This survey determines the current approach to treatment among Nigerian paediatric surgeons and should help in establishing a consensus and guidelines for care in this and similar setting.

Materials and Methods: An online questionnaire was designed using survey Monkey® to determine current clinical and operative management of patients with HD by consultant paediatric surgeons practicing in the Nigeria. The paediatric surgeons were notified by E-mail, which included a link to the survey on survey Monkey®. The survey was also administered at the 12th annual meeting of Association of Paediatric Surgeons of Nigeria in September, 2013, to capture those who did not complete the online survey. Thirtyone paediatric surgeons from 21 different tertiary paediatric surgery centres completed the survey.

Results: Sixteen (52%) respondents see up to 20% of their patients with HD in the neonatal period. Twentysix (84%) respondents do routine barium enema. Twenty six (84%) respondents do full thickness rectal biopsy under general anaesthesia (GA). There was no consistency in operative  techniques, with transabominal Swenson’s operation being practiced
by 17 (57%) respondents and 11 (37%) transanal endorectal pull through. 14 (45%) do pull through at any age. 12 (39%) respondents do more than half of their patient as primary pull through.

Conclusion: Full thickness rectal biopsy under GA is still the vogue with variations in the surgical  technique for management of Hirshsprung’s disease in Nigeria. Primary pull through procedures is becoming  increasingly popular. There’s a need for Paediatric Surgeons in Nigeria to Original Article come up with a guideline on management of HD, to guide trainees and other surgeons in the care of these patients.

Key words: Hirschsprung’s disease, management, primary pull through, rectal biopsy