The treatment and postoperative complications of Hirschsprung's disease

One hundred and ten patients with Hirschsprung's disease diagnosed and treated from 1981 to 1990 at the Royal Children's Hospital, Melbourne, were studied retrospectively. Eighty (72.7%) were treated by the Boley modification of the Soave procedure, 13 by the original Soave procedure, 13 had a Duhamel operation, and 4 had other procedures. Postoperative mortality was 2.7% (3 patients, 2 of whom died of early complications). Early postoperative complications occurred in 29 patients (26%); the most common was bowel obstruction, which included anastomotic obstruction (16 cases). Eight of these patients required anal dilatation to resolve obstruction. Enterocolitis occurred in 5 patients. There were no significant differences in incidence of early complications related to surgical procedure. Late postoperative complications occurred in 43 (39%) cases. Enterocolitis developed in 31 patients, with 19 requiring anal dilatation; 17 had bowel obstructions at various levels. The incidence of bowel obstruction was significantly higher in post-Boley patients (P <0.05). Length of follow-up was up to 10 years (average: 3.9 years). At the final follow-up (average age: 5.4 years) nearly 20% of patients were constipated, and 20% had some degree of incontinence or soiling. One half of the patients had normal bowel habits.