Initial Diversion in Hirschsprung’s Disease: Loop versus End Colostomy. Does it Make a Difference?

Abstract

Background: Staged surgery for Hirschsprung’s disease involving initial stoma formation with biopsies to find the level of aganglionosis and subsequent pull-through procedure like Duhamel’s Pull through is the most recommended management protocol at several institutions. The nature of stoma, whether loop or end, often determines the patient’s morbidity in this approach and would also have a say in the duration and ease at the time of definitive pull-through procedure. Aims and Objectives: To compare loop and end colostomy as diversion procedure for managing Hirschsprung’s disease. Materials and Methods: Retrospective Data of 70 cases of Hirschsprung’s disease operated for levelling biopsy and stoma formation (either loop or end colostomy) between January 2016 to December 2018 in the department of paediatric surgery at a tertiary care hospital were collected and analysed. Results: Loop colostomies with levelling biopsies were faster to fashion (mean 58 minutes) compared to End stoma with biopsies in Hartmann’s fashion (mean 72 minutes); they had more wound dehiscence, wound infection, stomal prolapse, peri-stomal herniation and peri-stomal skin rashes. Subsequent pull through procedure was faster and needed less dissection with less blood loss and fewer 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 safer with fewer complications compared to loop stoma for initial diversion in Hirschsprung’s patients; subsequent pull through is easier and safe when compared to loop colostomies.

Keywords: Aganglionic segment, Duhamel’s procedure, end colostomy, Hirschsprung’s disease, loop colostomy

Cite this Article

Ramdhani Yadav, Digamber Chaubey, Pallavi Suman, Sandip Kumar Rahul. Initial Diversion in Hirschsprung’s Disease: Loop versus End Colostomy. Does it Make a Difference? Research & Reviews Journal of Surgery. 2019; 8(3): 4–8p.