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.