Intestinal stomas in Hirschsprung’s disease: one clinic experience

BACKGROUND: Over its long history, Hirschsprung’s disease surgery has undergone significant changes: traumatic trait of the applied techniques decreased due to the introduction of laparoscopy, surgical stages at the perineum and pelvis became less aggressive due to the rational use of various electrosurgical equipment, the desire to eliminate the disease in one-stage intervention arose. However, for a number of objective reasons, in some situations, disease treating requires step-by-step correction through preliminary ostoma surgery and a series of subsequent surgical interventions.

AIM: To analyze the effectiveness of preventive stomas in various parts of the intestinal tube in patients with an established diagnosis of congenital colon agangliosis.

METHODS: A single-center retrospective study of 111 medical records of children with Hirschsprung’s disease treated in the department of neonatal surgery and surgical department No 1 of the City Ivano-Matreninsk Children’s Clinical Hospital in Irkutsk was conducted from 2001 (January) to 2024 (December).

RESULTS: Of the observed series, 79/111 (71.2%) cases of stage-by-stage treatment of degenerated agangliosis using preliminary stomatology were analyzed, 32 patients were excluded from the analysis due to simultaneous surgical correction of the defect. In 44,3% (n=35), the formation of stom at the place of the child’s primary treatment. Indications for stomy: age―69 (87.3%), the extent of agangliosis―19 (24.1%), decompensated form―18 (22.8%), repeated interventions―55 (69.6%), inability to treat and prepare enemas―9 (11.4%), Hirschsprung-associated enterocolitis―16 (20.3%). Distribution in relation to intestinal segments: ileostomy―55 (69.6%), colostomy above the level of agangliosis―20 (25.3%), sigmostomy to the transit zone―4 (5.1%). According to the method of formation: double―68 (86.1%), terminal―7 (8.9%), T-shaped (Bishop-Koop)―4 (5.1%). The age of children at the time of stomy is from 2 days to 14 years old. The closure was carried out as an independent final stage after reconstruction in 96.2% of cases.

CONCLUSION: The analyzed results have demonstrated that intestinal stomas in the treatment of colon agangliosis is a forced and preventive measure. Indications for stoma formation are most often the following: defect shape, initial somatic background, severity of chronic fecal intoxication equivalents, repeated surgical interventions, concomitant pathology, inability to prepare the intestine for reconstructive interventions by conservative methods.