Endorectal pull-through for Hirschsprung's disease - Report of 78 cases

From 1 July 1974 to 30 June 1987, 78 patients with Hirschsprung's disease underwent Soave's endorectal pull-through at the Hadassah University Medical Center in Jerusalem; 12 patients treated by Swenson or modified Duhamel procedures are not included in this report. All the patients were initially diagnosed and treated at our institution. Sixty-three (80%) had standard rectosigmoid disease; 15 (20%) had longer aganglionic segments; and 1 had total colonic aganglionosis. The diagnosis was made in 45 neonates (58%) and 28 infants (36%). Only 5 children were older than 1 year at diagnosis. Seventy-five patients (96%) underwent initial colostomy performed closely proximal to the "transition zone". The definitive Soave endorectal pull-through was performed in the majority of the patients before the age of 1 year. There was no mortality. A relatively low morbidity was encountered and all the patients are continent after follow-up periods of 1 to 13 years. In view of its gratifying results, Soave's endorectal pull-through is our preferred definitive procedure for Hirschsprung's disease in infants and young children.