Primary Swenson pull through in infants less than 4-months : preliminary report

Background: In our center, our approach has been to practice the traditional staged procedure for the treatment of Hirschsprung’s disease. This prospective study was to determine the feasibility of early neonatal pull through and in infants less than 4 months.
Methods: 5 consecutive patients with Hirschsprung’s disease under 4 months of age were recruited in to the study. Full thickness rectal biopsy confirmed the diagnosis in all the patients. A primary definitive Swenson’s pull through was using standard technique with intraoperative frozen section when available. Perioperative Ceftriaxone and metronidazole was administered preoperatively. A rectal tube made from a 2cc syringe was left in situ for 5-7 days after the operation
Results Four of the patients were seen within the neonatal period and a patient presented at 13 weeks, the male to female ratio is 4:1. The mean weight at admission is 3.20kg while the mean weight at surgery was 3.75kg. Intra-operative frozen section revealed that two patients had aganglionosis up to the proximal sigmoid colon while 2 other patients had an aganglionosis up to the proximal descending colon and the distal transverse colon respectively. All the patients were commenced with oral intake on or before 4th post-operative day. Wound infection and paralytic ileus occurred in the immediate post operative period in one patient each while another developed an incisional hernia. None of these complications was life threatening and were all managed as required. Bowel opening in the patients range from 2-5 times daily.
Conclusions. Based on this preliminary study it can be concluded that primary neonatal and early infancy pull through is feasible and advantageous to the patients. Further prospective works in this area are needed coupled with improvement in the neonatal care facilities.