A survey of current practices in management of Hirschsprung′s disease in Nigeria

Nasir, Abdulrasheed A; Ameh, Emmanuel A.

doi:10.4103/0189-6725.132797

Cited by 2 publications

(3 citation statements)

References 27 publications

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“…In one report, it was observed that only about 35% of paediatric surgeons indicated that they performed TERPT for their patients with HD in Nigeria and our centre is one of the pioneers for TERPT in this region. [ 1 ]…”

Section: Discussionmentioning

confidence: 99%

“…Where transanal pull-through is performed, the Soave type is more common than the Swenson technique in Nigeria. [ 1 ] TERPT has been the surgical choice for the treatment of HD in our centre for about two decades now. Long-segment disease requires laparotomy or laparoscopically assisted approach.…”

Section: Discussionmentioning

confidence: 99%

“…This technique has been practiced in Nigeria for over 15 years but less so in sub-Saharan Africa. [ 1 ] An important benefit of transanal pull-through is the absence or minimal abdominal manipulations, especially when combined with laparoscopy or laparotomy. Laparoscopy as an effective tool for colonic biopsy, identification of transitional zone, and mobilisation of the colon is well established.…”

Section: Introductionmentioning

confidence: 99%

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Outcome of Transanal Endorectal Pull-Through in Patients with Hirschsprung’s Disease

Sholadoye¹,

Alfa²,

Mshelbwala³

et al. 2023

African Journal of Paediatric Surgery

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Background: Transanal endorectal pull-through (TERPT) has become one of the preferred treatments for Hirschsprung’s disease (HD) in our setting. This report aims to evaluate the current outcome of TERPT in the setting. Materials and Methods: A retrospective review of 71 children who had TERPT for histologically-confirmed HD in 11 years (2006–2017) in Nigeria. Results: There were 48 boys and 23 girls; aged 3 days–12 years at initial presentation (median = 10 months). Three (4.2%) patients had associated anomalies (duodenal atresia; anorectal malformation and sensorineural deafness with hypopigmented skin patches each). Age at TERPT was 2 months to 15 years (median = 3 years), with surgery waiting time of 1 month-14.9 years (median = 18 months). Sixty-six (93.0%) patients had rectosigmoid, four (5.6%) patients had long segment and one (1.4%) had total colonic disease. Five (7.0%) patients with large megacolon and one (1.4%) with the total colonic disease had assisted abdominal resection of the colon at TERPT. Seventeen (23.9%) patients had post-operative complications, including post-operative enterocolitis 8 (11.3%); anastomotic dehiscence 3 (4.2%); retained aganglionic segment 2 (2.8%); anastomotic stenosis 2 (2.8%), resulting in prolonged hospital stay (P = 0.0001; range = 1–30 days; median = 5 days). The mortality rate was 4.2% (3) from malignant hyperthermia in one patient and in 2 patients, the cause of mortality was unclear. Patients were followed up for 3–6 years (median = 3.5 years). Bowel movement stabilised to 2–4 times daily by 6 weeks after surgery. Conclusion: TERPT is a safe treatment for HD in this setting with good short-term outcomes. Longer follow-up is necessary to further evaluate the long-term bowel movement outcomes.!

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Outcome of Transanal Endorectal Pull-Through in Patients with Hirschsprung’s Disease

Sholadoye¹,

Alfa²,

Mshelbwala³

et al. 2023

African Journal of Paediatric Surgery

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Pull-Through of Ganglionic Stoma in Children with Hirschsprung’s Disease Living in a Low Resource Context Spares Further Surgery for Colostomy Reverse

Calisti¹,

Tresphory²,

Mlawa³

2023

African Journal of Paediatric Surgery

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Background: One-step pull-through for Hirschsprung’s disease (HSCR) is already standard in many tertiary African paediatric surgical centres where radiology and frozen sections are available. However, limited resources in many peripheral areas associated with advanced age at referral or complicated presentation make recourse to colostomy often unavoidable with a consequent three-step surgery. To simplify these children’s clinical course and spare the burden of a third procedure for colostomy reverse, a direct pull-through of the proximal ganglionic stoma is proposed. Materials and Methods: Twenty children (male/female ratio 19/1) between 3 months and 13 years with a colostomy for a suspected HSCR were selected for stoma pull-through among patients admitted to a regional Tanzanian hospital between 2016 and 2022. Histological diagnosis was always confirmed by rectal biopsies and, in some cases, colonic specimens taken during the stoma confection or revision. A ganglionic stoma was always ascertained before the pull-through procedure (11 Transanal Endorectal, 4 Soave and 5 Duhamel). Results: One death was registered in a child with Down syndrome, unrelated to surgery, and another due to HSCR acute associated enterocolitis. One stenosis required stricturoplasty, and one anastomotic leakage needed temporary ileostomy. No relationship was found between complications and the procedure of choice. Passage of stools started on the 2nd day and became regular and without soiling in a week. Conclusions: Straightforward pull-through of the ganglionic stoma may be a feasible solution for patients with HSCR and a diverting colostomy to avoid a three-step procedure. The correct position of the stoma at the transition zone must be ascertained to avoid the risk of including in the resection segment of the ganglionic bowel.

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A survey of current practices in management of Hirschsprung′s disease in Nigeria

Cited by 2 publications

References 27 publications

Outcome of Transanal Endorectal Pull-Through in Patients with Hirschsprung’s Disease

Outcome of Transanal Endorectal Pull-Through in Patients with Hirschsprung’s Disease

Pull-Through of Ganglionic Stoma in Children with Hirschsprung’s Disease Living in a Low Resource Context Spares Further Surgery for Colostomy Reverse

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