RESULTS OF SURGICAL TREATMENT OF HIRSCHSPRUNG’S DISEASE IN CHILDREN

Abstract

Relevance. Surgical correction of Hirschsprung’s disease in children is one of the most complex and relevant problems in pediatric surgery. Significant progress in addressing this condition has been achieved over recent decades due to the introduction of high-technology surgical treatment methods. However, despite improvements in many operative techniques and approaches, the rate of unsatisfactory functional outcomes in the long-term postoperative period remains as high as approximately 30% among all operated patients.

Aim. To improve and implement minimally invasive surgical methods for the treatment of rectal and rectosigmoid forms of Hirschsprung’s disease in children.

Materials and Methods. From 2017 to 2025, 95 preschool-aged children with rectal and rectosigmoid forms of Hirschsprung’s disease were treated as inpatients at the Pediatric Surgery Clinic of the Tashkent Pediatric Medical Institute. The patients were divided into two comparative groups. The first (control) group included 29 patients (30.5%) who underwent traditional open surgical procedures. The second (main) group consisted of 66 patients (69.5%) who underwent video-assisted transanal endorectal Swenson-like procedures with resection of the aganglionic segment.

Results and Discussion. A comparative analysis of surgical interventions for rectal and rectosigmoid forms of Hirschsprung’s disease was performed based on a differentiated approach to the selection of corrective methods and techniques. Traditional open surgical procedures were carried out using the Soave–Lyonushkin method in 17 patients (17.9%) and the O. Swenson method in 12 cases (12.6%). The rationale for choosing these open techniques was that, in preschool-aged children with rectal and rectosigmoid forms of Hirschsprung’s disease, submucosal dissection can be performed relatively easily even in the presence of a long aganglionic segment of the colon.

Minimally invasive video-assisted transanal endorectal procedures with resection of the aganglionic segment of the colon for rectal and rectosigmoid forms of Hirschsprung’s disease were performed using the Swenson-like method in 18 patients (18.9%) and the De La Torre–Mondragón technique in 48 patients (50.5%).

Conclusion. The conducted studies clearly demonstrate that in the treatment of rectal and rectosigmoid forms of Hirschsprung’s disease in children, preference should be given to minimally invasive transanal endorectal pull-through techniques, as they are less traumatic, more tissue-sparing, and more effective in terms of radicality and physiological appropriateness of the intervention. Traditional extensive open surgical procedures are characterized by greater technical complexity, insufficient functional outcomes, and comparatively poorer immediate and long-term results, often necessitating repeated surgical corrections and prolonged rehabilitation measures.