Early Outcome of Open Primary pull through Versus Staged pull through in Hirschsprung's Disease: A Single Centre Experience from Nigeria.

Abstract

Background: The treatment of Hirschsprung's disease has followed a trend from 2 or 3-staged pull-through (SPT) procedures to a single stage primary pull-through (PPT) procedure and from open surgery to laparoscopy-assisted, and trans-anal pull through procedures. The (PPT) procedure has the advantage of avoiding a stoma and its complications.
Objective: This study compares the outcomes in open PPT and SPT in our centre.
Methods: Retrospective observational study at a single centre from Nigeria over a 4year period.
Results: Of 46 patients with Hirschsprung's disease, 29 patients had pull-through procedures during the study period; 19 had SPT and 10 had PPT. There were 21 boys and 8 girls (M:F = 2.6:1). Five (17.1%) were diagnosed in the neonatal period and median age at surgery was 30months (1 month – 31yrs). The mean length of hospital stay was 30 days (±7) in the SPT group while it was 16days (±3) in the PPT group, p<0.05. Colostomy morbidity such as prolapse and skin excoriation showed statistical significant difference compared to other complications associated with pull-through (p<0.05); however morbidity from pullthrough procedures alone were similar. There was no statistically significant difference in post operative bowel habit irrespective of type of pull through operation performed (p>0.05). Patients were followed up for between 3 months and 36 months. Two patients died giving a mortality rate of 6.7% overall.
Conclusion: PPT significantly reduced both hospital stay and colostomy complications compared to SPT

Keywords: Hirschsprung's disease, primary pull-through, staged pull-through