Experience in the Treatment of Hirschsprung’s Disease in Adults

M.M. Mirzakhmedov

Abstract


Hirschsprung’s disease is a severe malformation of the colon and is on one of the leading places in the structure of the digestive tract diseases in adults. Despite the modern development of coloproctology, issues regarding the features of the disease, its dependence on the morphological changes of the wall of the colon, diagnosis, and treatment policy for Hirschsprung’s disease in adults to date remain valid, which requires further study.
Objective. To improve the diagnosis and determine the most effective ways of surgery for Hirschsprung’s disease in adults.
Materials and Methods. The study involved 82 patients (male — 58 (70.7 %), female — 24 (29.3 %)) with Hirschsprung’s disease, examined and treated in the Scientific center of coloproctology of Uzbekistan from 1990 to 2013. The age of patients was from 15 to 46 years. All patients underwent clinical and instrumental examination. We began from careful study of complaints, medical history, and then carried out general clinical proctologic examination: endoscopic, radiological, physiological (sphincterometry, balloonography, electrocolography), morphological (the study of biopsy material and operational preparations) for the comparative analysis of the effectiveness of surgical treatment of patients with Hirschsprung’s disease. We divided them into 2 groups.
The study group consisted of 28 patients with Hirschsprung’s disease, in whom abdominal-anal resection of the rectum was performed with bringing down the proximal colon to the anal canal.
The control group consisted of 44 patients with Hirschsprung’s disease who underwent Duhamel surgery.
Results and Discussion. In our observations of the 82 surveyed in 46 (56 %) were supraanal, 20 (24.4 %), rectal, and 13 (15.9 %), rectosigmoid and 2 (2.5 %) left and one (1.2 %) subtotal hypoganglionic zone.
According to Swenson biopsy in our study of 82 patients, 36 (44 %) — aganglionosis identified and in 46 (56 %) hypogangliosis rectum in the analyzed group of patients, early postoperative complications were the main group in 4 (22.3 %) patients and in 14 (77.7 %) in the control group. Death was reported in 1 (1.2 %) case. Late postoperative complications were observed in 7.1 % of primary and 15 % in the control group. Long-term results of surgical treatment were estimated according to VISIC scale.
Conclusion. In our experience, most adequate and radical treatment Hirschsprung’s disease in adults is surgery of abdominal-anal resection of the rectum with bringing down in the anal canal of the proximal colon. It is aimed at the removal of hypo- or aganglionic zone and decompensated parts of the colon and meets radicalism.


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DOI: https://doi.org/10.22141/1997-2938.2.21.2013.87512

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