Hirschsprung’s disease requires surgical treatment. Depending on the form of aganglionosis and severity of pathology, open or minimally invasive, one-stage or multi-stage radical surgery may be used.
The objective of the research was to develop an algorithm for surgical treatment of children with Hirschsprung’s disease.
Materials and methods. The analysis of surgical treatment of 1,129 children with different forms of Hirschsprung’s disease aged from birth to 18 years over the period 1980-2018 was conducted. All the patients underwent both traditional and minimally invasive radical surgery.
Results and discussion. The patients were divided into three groups; each group was characterized by modernization of surgical methods, as well as intensification of diagnostics for early detection of such patients. Radical surgery without a protective colostomy was used in 773 (68.46%) cases, while in 356 (31.53%) cases, a protective colostomy was created. Due to the intensification of diagnostics that markedly contributed to early detection of patients with various forms of Hirschsprung’s disease, during each study period, there was observed a dramatic decrease in the number of stoma patients with a significant increase in the number of children diagnosed with Hirschsprung’s disease: from 68.54% (1980-1992) to 37.93% (1993-2010) and 12.00% (2011-2018).
Conclusions. Timely diagnostics contributes to early detection of children with different forms of Hirschsprung’s disease. In uncomplicated forms of Hirschsprung’s disease, it is reasonable to perform one-stage radical surgery, namely the resection of the aganglionic segment and the affected colon segment followed by colorectal anastomosis. In severe Hirschsprung’s disease, two-stage surgery should be used: creation of a protective colostomy (the first stage) and radical surgery (the second stage). In some cases, in colectomy, three-stage surgical approach is needed, namely the creation of a protective colostomy (the first stage), radical surgery (the second stage) and protective colostomy closure (the third stage).
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