Annals of Surgery

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Annals of Surgery:
Scientific Papers

A Decade of Experience With the Primary Pull-Through for Hirschsprung Disease in the Newborn Period: A Multicenter Analysis of Outcomes

Teitelbaum, Daniel H. MD*; Cilley, Robert E. MD†; Sherman, Neil J. MD‡; Bliss, David MD†; Uitvlugt, Neal D. MD§; Renaud, Elizabeth J. MD‡; Kirstioglu, Irfan MD*; Bengston, Tamara PA§; Coran, Arnold G. MD*

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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.

© 2000 Lippincott Williams & Wilkins, Inc.


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