Post surgical complications of hirschsprung's disease and their management at Kenyatta National Hospital:a 10-year retrospective study
Abstract
This is a retrospective study of the post-surgical complications of Hirschsprung's
disease and their management at Kenyatta National Hospital during the period
January 1991 to December 2000. Medical records of 96 patients who underwent
surgery for histologically proven Hirschsprung's Disease at Kenyatta National
Hospital and any associated colostomies closed were reviewed. Aganglionosis
extended upto the rectosigmoid region in 75 (78.1 %), proximal to the internal anal
sphincter in 15 (15.6%) and proximal to the splenic flexure in 6 (6.3%)
The surgical procedures employed included Swenson's pull-through in 54 (56.3%),
Soave-Boley endorectal pull-through in 39 (40.6%) and myectomy in 3 (3.1%). No
patient had definitive surgery in the neonatal period, while 16 (16.7%) had surgery
between one month and one year and 80 (83.3%) after one year oflife.
Seventeen (17.7%) of the definitive procedures were one-stage, 17( 17.7%), 2- stage
and 62 (64.%) were 3-stage procedures.
Early post-operative complications occurred in 17(17.7%) and late complications in
70 (72.9%). The main complications observed were persistent constipation in 25
(26.0%), ano-rectal stenosis in 20 (20.8%), faecal incontinence in 21 (21.9%) and
enterocolitis in 11(11.5%).
Anorectal stenosis was commonest after a Soave-Boley procedure (55%) compared
with Swenson's (45%). Persistent constipation and faecal incontinence occurred
almost equally following any of the surgical procedures but were commoner in
those undergoing surgery at a later age and in those undergoing staged operations.
The incidence of postoperative enterocolitis was higher in children who underwent
surgery at an age of less than one year. Recurrent symptoms were commoner after
Swenson's pull-through and in those with long segment disease but equally
common among those in whom the histology of the proximal end of the resected
segment was reported as irregular or aganglionic compared with those in whom it
was reported as regular.
Nineteen patients underwent repeat pull through. The most common indications
for redo procedures were anorectal stenosis and incomplete resection of the
aganglionic colon. The Swenson's procedure was the preferred procedure in
twelve patients, Soave-Boley in two and myectomy in five.
Citation
Degree Of Master Of Medicine (surgery) Of The University Of Nairobi, 2003Publisher
University of Nairobi. Department of Surgery