Modern approaches and the effectiveness of one-stage operations in the surgical treatment of Hirschsprung's disease

Abstract

Objective: to assess the effectiveness of single-stage minimally invasive surgery in children with Hirschsprung’s disease (HD) and to identify its advantages over traditional multi-stage approaches.

Material and methods: the study was conducted at the Department of Surgery of the Medico-Social Institute of Tajikistan and at the “Istiqlol” Clinical Center between 2016 and 2024. A total of 143 patients with clinically and morphologically confirmed HD were included in the study. The patients were aged between three days and 17 years. The study compared two groups: Group I comprised patients who underwent one-stage surgery (n = 30), while Group II comprised patients who underwent multi-stage interventions involving colostomy (n = 113). The methods used included ultrasonography, contrast enema (irrigography), endoscopy, sphincterometry and histology.

Results: complications occurred significantly less frequently in the one-stage surgery group (2.8% vs. 13.3%; p < 0.01). Normal defecation was also achieved more often in this group (90.7% vs. 69.2%; p < 0.05), as was sphincter function preservation (95.3% vs. 76.9%; p < 0.05). The average length of hospitalization was 7.5 ± 1.2 days compared to 18.3 ± 2.7 days (p < 0.001). Toxic liver injury was detected in 69.2% of patients in the second group (p < 0.01), whereas no such cases were recorded in the first group.

Conclusion: one-stage operations for HD provide superior functional and metabolic outcomes, reduced hospitalization time, and minimize the risk of complications. In the absence of contraindications, this should be considered the method of choice in pediatric surgical practice.