Treatment of Hirschsprung's disease without colostomy

The authors report 21 cases of Hirschsprung's disease with severe neonatal symptoms: intestinal obstruction, enterocolitis, and necrotizing enterocolitis. The goal of the approach was to avoid colostomy. After the diagnosis was established, prompt treatment was begun usually with total parenteral nutrition (TPN) via a central catheter. In the first 11 patients surgery was performed at an average age of 8 months, starting preoperatively with an elemental diet. From 1987,to 1990, 10 patients were treated. After a period,of TPN and complete resolution of intestinal symptoms, an early Soave pull-through was performed at an average age of 34 days. Follow-up varied from 16 months to 8 years. The results were excellent: there were no anastomotic leaks or infections and stenosis was prevented by means of periodic calibrations and/or dilitations. Evacuations were regular in all cases. Correspondence to: C. Del Rossi