Intestinal stomas in the treatment of Hirschsprung's disease: the experience of one clinic

BACKGROUND: over its long history, Hirschsprung's disease surgery has undergone significant changes: the traumatic nature of the methods has decreased due to the introduction of laparoscopy, the stages of work on the perineum and pelvis have become less aggressive due to the rational use of various electrosurgical equipment, the desire to eliminate the disease in one stage has appeared. However, for a number of objective reasons, in some situations, the strategy of treating the disease requires a step-by-step correction through preliminary stomatology and a series of subsequent surgical interventions. Aims:: to analyze the use 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 in the period from 2001 (January) to the present (December 2024). RESULTS: In 71.2% (79), stage-by-stage treatment of congenital agangliosis through pre-stomy. In 88.6% (70), the stoma was removed as the first stage of correction. In 44.3% (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 (GAEC) – 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 analysis of the results showed that the use of intestinal stomas in the treatment of colon agangliosis is a forced and preventive measure. Often, the indication for the formation of a stoma is the form of the defect, the initial somatic background, the severity of the equivalents of chronic fecal intoxication, repeated surgical interventions, concomitant pathology, the inability to prepare the intestine for reconstructive intervention by conservative methods.