Transanal Swenson Procedure for Pediatric H.D., Advantages and Disadvantages

Document Type : Original Article

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The Department of Pediatric Surgery, Faculty of Medicine, Mansoura University

Abstract

Background: In infants, intestinal obstruction is most com-monly caused by Hirschsprung’s disease (HD). An aganglionic segment at the level of the rectosigmoid colon is present in 70% to 80% of individuals. Aim of Study: This study evaluates operative details, post-operative outcome and complications of trananal Swenson for pediatric H.D. Patients and Methods: 56 patients were included in this study in the period from (June 2018-July 2021) at Mansoura University Children Hospital. All cases were diagnosed by his-tory, barium enema and rectal biopsy. They underwent transanal Swenson with full thickness incision 1cm above the dentate line and the aganglionic segment was resected, with evaluation of operative details, post-operative outcome and complications (6 months-12 months). Results: This study was including 56 cases (35 male, 21 female), with age ranged from 4 months to 5 years. The opera-tive time ranged from (80 minutes-140 minutes). The length of the resected aganglionic segment ranged from (15cm - 43cm). There was no significant blood loss except in one case that need-ed blood transfusion. Post-operative hospital stay ranged from (3-7 days). 2 cases suffered from anastomotic leak that required exploration and colostomy. 5 cases presented by post-operative constipation which were managed conservatively, except one case that required internal sphincter myectomy. 6 cases suffered from post-operative soiling with perianal excoriation and man-aged by medical treatment and biofeedback. 3 cases suffered from enterocolitis with conservative management. There were no urinary problems or drippling. Conclusion: The transanal Swenson procedure for H.D. is a good technique with short operative time, insignificant blood loss and accepted post-operative outcomes and bowel habits. This technique avoids the problems associated with long mus-cular cuff of transanal Soave procedure, but it carries the risk of anastomotic leak and soiling.

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