LOOP COLOSTOMY VERSUS END COLOSTOMY FOR INITIAL STAGE SURGERY IN CHILDREN WITH HIRSCHSPRUNG’S DISEASE
Journal Title: Journal of Indira Gandhi Institute of Medical Sciences - Year 2019, Vol 5, Issue 1
Abstract
Abstract Background: Staged surgery for Hirschsprung’s disease involves an initial stoma formation with biopsies to determine the level of aganglionic segment, followed by a pullthrough procedure like Duhamel’s pullthrough. Stoma type with the least complication rate and providing considerable ease during subsequent pullthrough procedure would be the preferred stoma technique as the initial step in Hirschsprung’s disease. Aims and Objectives: To compare loop colostomyand end colostomy as the initial stage in managing Hirschsprung’s disease. Materials and methods: Data regarding 70 cases of Hirschsprung’s disease operated for levelling biopsy and stoma formation (either loop or end colostomy) between 01.01.2017 to 31.12.2018 in the department of Pediatric surgery in a tertiary care hospital were collected prospectively and analyzed. Results: Although loop colostomies with levelling biopsies took less time to be fashioned (mean 58 minutes) compared to End stoma with biopsies in Hartmann’s fashion (mean 72 minutes), they were associated with more incidences of wound dehiscence, wound infection, stomal prolase, peri-stomal herniation and peri-stomal skin rashes. Subsequent pullthrough procedure was faster with less dissection and blood loss and overall complications including stump leak in patients who had been diverted via end stoma compared to those who had had loop colostomy at the time of initial surgery. Conclusion: End colostomy in Hartmann’s fashion is the preferred and safer mode of diversion in Hirschsprung’s patients lessening the complication rate and making subsequent pullthrough easier and safe when compared to loop colostomies.
Authors and Affiliations
Jaheer Hasan
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