Treatment options

Treatment of Hirschsprung's disease consists of resecting the aganglionic segment of the rectum and colon, pulling down normally innervated bowel and anastomosing this bowel at the anorec-tal region, while preserving the sphincter muscle. The past decade has seen an evolution in the surgical management of Hirschsprung's disease. The previous gold standard of two- or three-stage pull-through with a preliminary stoma has slowly been replaced by a one-stage approach in many centers.22-24 More recently, minimally invasive approaches to the one-stage pull-through have become popular. These consist of pull-throughs utilizing laparoscopic abdominal and pelvic mobilization of the rectum and the transanal Soave procedure, which does not include any intraabdominal dissection.25-30 The one-stage approach, either by laparotomy or by combined laparoscopy and transanal dissection, has been advocated even in the newborn period.

The results of the one-stage approach in small infants appear to be at least as favorable as those in which a staged procedure with a colostomy was used. Recently, the use of the one-stage definitive procedure for small infants with Hirschsprung's disease has increased. One-stage pull-through procedures using laparoscopy appear to be associated with shorter hospital stays, shorter time until full feeding is reached and superior cosmetic results.31-32

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