Hirschsprung Pull Through

About Hirschsprung Pull Through

The pull through procedure is the main operation for Hirschsprung disease, a congenital condition in which nerve cells called ganglion cells are missing from the end of the bowel, preventing normal movement of stool. Most affected children are diagnosed in the newborn period, often after failing to pass meconium or developing a distended abdomen, and diagnosis is confirmed by rectal biopsy. The operation removes the segment of bowel lacking nerve cells and brings healthy, normally innervated bowel down to just above the anus. Classic techniques named after their developers include the Swenson, Duhamel and Soave procedures. Historically the operation was done in stages with a temporary colostomy, but many children are now treated with a single stage operation, often performed through the anus alone, a transanal endorectal pull through, or with laparoscopic assistance. When the aganglionic segment is very long, surgery is more complex. The disease was described by the Danish physician Harald Hirschsprung in the late nineteenth century. Long term follow up by pediatric surgeons is common because bowel function can remain affected.