Pradip Kumar Deuri

BACKGROUND:  The most common cause of bowel obstruction in the neonates is Hirschsprung’s disease. Traditionally Hirschsprung’s disease was managed in stage procedure of colostomy, the definitive pull-through followed by closure of colostomy but Primary Transanal Endorectal Pull-Through procedure is a recent development in the concept of the management of Hirschsprung’s disease through minimally invasive surgery. In this study we represent our early experience to evaluate the feasibility and safety of Primary Transanal Endorectal Pull-Through for management of Hirschsprung’s disease during early neonatal period. METHODS Six male and four female neonates with Hirschsprung’s disease were included in this study. The age ranged from 3-30 days. All babies presented with Hirschsprung’s disease was diagnosed with Barium enema study. The inclusion criteria included radiological transitional zone at rectosigmoid or mid-sigmoid region, weight more than 2.5 kg, abdominal distention response to rectal decompression, no evidence of enterocolitis and no associated major anomaly. This is a retrospective study of early neonates with primary transanal endorectal pull-through procedure done for Hirschsprung’s disease in our institute from January 2012 to January 2016. RESULTS Six male and four female neonates who were included in the study underwent primary transanal endorectal pull-through. The mean operating time was 60 minutes and mean intra-operative blood loss was 20 ml. The mean length of bowel resected was 16 cms. Patients passed stool between 3rd and 4th day post-operatively. Oral feeding was started on 5th and 6th day postoperatively. The average post-operative hospital stay was seven days. None of the patients had post-operative bleeding, urethral injury, anastomotic leak or retraction of anastomotic sites and enterocolitis. Two patients had perineal excoriation. In this study there was no mortality. CONCLUSIONS Primary TEPT is both feasible and safe in the early neonatal period with advancement in paediatric anaesthesia, availability of expert paediatric surgeon, improvement in pre-operative and post-operative management and nursing care. Early results of the postoperative complications and functional outcome are comparable to cases treated with primary or multistage surgery in early neonates or childhood period.