Management of Hirschsprung's disease with the Swenson procedure with emphasis on long-term follow-up

Abstract

In a 20-year period (1965–1985), 80 patients with Hirschsprung's disease were managed with the Swenson procedure. Two-thirds of the patients had disease limited to the rectosigmoid and sigmoid colon. In the remaining patients, aganglionosis extended into variable lengths of colon, including 5 instances of total colonic aganglionosis. All patients had a protective enterostomy at the time of pull-through. There was no operative mortality and 1 late death due to fulminating enterocolitis. All but 1 of the remaining patients are in good health. One patient, lost to follow-up for 10 years, has chronic enterocolitis. No patients, including 7 who had anastomotic leaks, ever had problems with rectal stricture. There are no instances of urinary dysfunction or problems with male sexual function. Sixty-one patients have had long-term follow-up. Fifty-two have completely normal rectal function, although in some instances it was not achieved for several years. Eight patients are too young to evaluate. Four patients have minor problems with occasional fecal soiling, but are expected to recover. Only 2 of 5 mentally retarded patients are becoming toilet trained. Despite the appearance of many other operations designed to cure Hirschsprung's disease, the Swenson procedure is still employed by many surgeons. Long-term follow-up is necessary for final evaluation of rectal function.