Abstract
Background
Many options exist in the surgical management of Hirschsprung's disease (HD). To gain
insight into contemporary management, we queried pediatric surgeons listed in the
American Pediatric Surgical Association Directory on their management for the typical
baby with HD.
Methods
Surveys were sent electronically to the surgeons concerning a typical newborn diagnosed
with HD. Questions included the preferred approach, number of stages, anastomotic
technique, length of muscular rectal cuff, point of initiation of the anorectal dissection,
and length of colonic resection. Surgeons performing laparoscopy were asked about
how the colonic biopsy was performed. Other questions included the type of leveling
colostomy, level of residents, and criteria for performing a primary transanal pull-through.
The maximum margin of error was calculated using a 95% confidence interval based on
the response percentages for discrete variables.
Results
Surveys were sent to 719 surgeons with 270 responses. A minimally invasive approach
is currently used by 80%, of which 42.3% favor laparoscopy and 37.7% prefer transanal
dissection only. Only 5.4% of respondents prefer the Duhamel technique. A 1-stage
approach is used by 85.6%. An average muscular cuff length of 2.4 cm (range, 0.5-6
cm) is reported. A divided muscular cuff is reported by 55%. On average, the anal
anastomosis is 0.73 cm (range, 0-4.5 cm) above the top of the anal columns and 3.0
cm (0-12.5 cm) above the biopsy site on the ganglionic colon. Of the respondents using
laparoscopy, 80.2% report using an intracorporeal colonic biopsy technique. Participation
in a training program, either fellows and/or residents, is reported by 84.8% of respondents.
The most common reason given for not performing a primary transanal pull-through is
long segment disease (45.6%). Margin of error was no greater than 6% for any of the
responses.
Conclusions
A minimally invasive approach with a 1-stage operation has become the most common
strategy for the surgical management of the typical baby with HD. Opinions vary about
the amount of colonic resection, length of the rectal cuff, and site of initiation
of the anorectal dissection, and these represent potential points for future studies.
Key words
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Article info
Publication history
Accepted:
February 17,
2009
Received:
February 16,
2009
Identification
Copyright
© 2009 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
