One-stage neonatal reconstruction without stoma for Hirschsprung's disease.

Interest in primary one-stage reconstruction for Hirschsprung's disease has been increasing steadily because of the obvious clinical quality issues and resource benefits. This report describes one surgeon's 13-year experience with 52 children who had proven Hirschsprung's disease. The patients were managed in a neonatal surgical unit by a one-stage neonatal reconstruction without stoma. Results indicate that the procedure is not age- or weight-dependent; it should be considered only when parameters for safe neonatal anesthesia, nursing, surgery, and expert pathology are available. Complication rates have decreased with time and compare favorably with those of traditional "safe" multistage approaches. Children with Down's syndrome have a greater risk for complications because of poorer early healing and reduced resistance to infection, and more cautious postoperative management is required. Clinical quality issues, specifically absence of stoma-related concerns, fewer hospitalizations, and less need for surgical interventions, are significantly better. There were no procedure-related deaths. Given an appropriate infrastructure, the one-stage reconstruction without stoma is applicable in the neonatal phase, and is safe and effective therapy, having major quality and resource benefits.