Objective: To determine whether use of a primary pull-through would result in equivalent perioperative and long-term complications compared with the two-stage approach.
Summary Background Data: During the past decade, the authors have advanced the use of a primary pull-through for Hirschsprung disease in the newborn, and preliminary results have suggested excellent outcomes.
Methods: From May 1989 through September 1999, 78 infants underwent a primary endorectal pull-through (ERPT) procedure at four pediatric surgical sites. Data were collected from medical records and a parental telephone interview (if the child was older than 3 years) to assess stooling patterns. A similar group of patients treated in a two-stage fashion served as a historical control.
Results: Mean age at the time of ERPT was 17.8 days of life. Comparing primary ERPT with a two-stage approach showed a trend toward a higher incidence of enterocolitis in the primary ERPT group compared with those with a two-stage approach (42.0% vs. 22.0%). Other complications were either lower in the primary ERPT group or similar, including rate of soiling and development of a bowel obstruction. Median number of stools per day was two at a mean follow-up of 4.1 ± 2.5 years, with 83% having three or fewer stools per day.
Conclusions: Performance of a primary ERPT for Hirschsprung disease in the newborn is an excellent option. Results were comparable to those of the two-stage procedure. The greater incidence of enterocolitis appears to be due to a lower threshold in diagnosing enterocolitis in more recent years.
From the *Department of Surgery, Section of Pediatric Surgery, the University of Michigan Medical Center and the C.S. Mott Children’s Hospital, Ann Arbor, Michigan; the †M.S. Hershey Medical Center, Hershey, Pennsylvania; ‡Queen of the Valley Hospital, West Covina, California; and §Spectrum Health Center, Grand Rapids, Michigan
Correspondence: Daniel H. Teitelbaum, MD, Section of Pediatric Surgery, University of Michigan Medical Center and C.S. Mott Children’s Hospital, F3970, Box 0245, Ann Arbor, MI 48109.
Presented at the 120th Annual Meeting of the American Surgical Association, April 6–8, 2000, The Marriott Hotel, Philadelphia, Pennsylvania.
Accepted for publication April 2000.