Transanal Swenson's operation for Rectosigmoid Hirschsprung's disease

Abstract

Background: Transanal Swenson’s operation is a relatively new single-stage procedure for Hirschsprung’s disease. The results of this procedure at our centre are presented.

Patients and Methods: Seventeen patients of recto-sigmoid Hirschsprung’s
disease underwent single-stage transanal Swenson’s procedure. The  diagnosis was based on the evidence of a transition zone on barium  enema examination. A full thickness incision was made on the rectal wall posteriorly, 0.5 cm above the dentate line. The mobilised segment was resected about 5 cm above the transition zone. Frozen sections were  performed whenever the transition zone was not clearly seen intra- operatively. The operation was completed by full thickness colo-anal anastomosis.

Results: There were fourteen male and three female patients. The ages of the patients ranged from two months to eight years (median 14 months). The median hospital stay was four days (range four to seven days). Two  patients required additional abdominal mobilisation. The anatomical transition zone as seen intra-operatively correlated with the pathological transition zone in all the cases. Two patients had episodes of  postoperative enterocolitis and the other two patients developed stricture of the anastomosis. The followup period ranged from six to 45 months (Mean 35.4 months). Post-operative soiling was observed in all the  patients and lasted from two to six weeks (Mean 3.4 weeks). There were no injuries to the surrounding structures. No patient had voiding disturbances and post-void residual urine was normal in all the patients.
Initial increased frequency of bowel movements had settled to one to three per day.

Conclusions: Transanal Swenson’s pull through not only avoids laparotomy, but also the problems associated with the muscular cuff of transanal endorectal pull-through. The anatomical transition zone can be safely utilised to decide the resection limits. By a meticulous technique of dissection, injury to the surrounding structures can also be avoided.