Avaliação da cirurgia endoanal na doença de Hirschsprung: experiência do serviço de cirurgia pediátrica do Hospital Fundação Santa Casa de Misericórdia do Pará

Abstract

Hirschsprung's disease, since the discovery of its etiopathogeny, requires surgical correction as definitive treatment. Several techniques have been developed since then in order to improve the quality of life of children with this anomaly. This study aimed to present the experience of the Pediatric Surgery Department of Hospital Santa Casa de Misericórdia do Pará with the technique of Transanal Endorectal Pull-Through for the treatment of Hirschsprung's disease between January 2008 and January 2009. The research was of the nature descriptive longitudinal. Data were collected from medical records of patients undergoing surgery, supplied by the Medical Archives and Statistics Service of the Santa Casa de Misericórdia do Pará, according to a specific protocol form. There was male predominance of 77% of patients. The age at treatment ranged from 7 to 121 days with an average of 2 years and 8 months (± 39.6 months). Of all patients 39% had colostomy prior and preoperative enterocolitis was diagnosed in 15.4%. The total length of hospitalization ranged from 9 to 24 days and after surgery ranged from 4 to 20 days. The average weight of patients was 8 ± 6.06 kg and average duration of surgery was 92 minutes. The recovery of the intestinal function ran on average 40 ± 24.09 hours and oral feeding started 97 ± 35.36 hours after surgery. The average follow-up was 6 ± 2.43 months. The postoperative complications occurred in 30.8% of cases varying in prolapse of the rectal mucosa (25%), abdominal distension (25%) and wound infection (50%). Further complications occurred in 46.2% of patients ranging in anal incontinence (33.3%), perianal rash (33.3%), perianal mycosis (33.3%) and anal stenosis (16.7%). There were no deaths, associated diseases and postoperative enterocolitis. Our findings enhance the information of available literature on the utilization of the technique of Transanal Endorectal Pull-Through, although not yet possible to comment about the functional results in such a short interval follow-up.