Current management of Hirschsprung’s disease in Egypt: a survey of members of the Egyptian Pediatric Surgical Association

Background/purpose Significant progress has been
made in the management of Hirschsprung’s disease (HD).
The choice of the management plan, surgical approach,
and operative details is still variable among pediatric
surgeons. This survey aims to determine the current
preferences of Egyptian pediatric surgeons in the
management of HD.
Materials and methods A survey was circulated
individually to the members of the Egyptian Pediatric
Surgical Association (EPSA) during the General Assembly
Meeting. An electronic form of the survey was sent by
e-mail to all Egyptian consultant pediatric surgeons
registered to EPSA through the ‘EPSA online’ e-mail group.
A second round of e-mails was sent 2 weeks later.
Results Responses were received from 112 surgeons;
seven responses were excluded (incomplete and duplicate
responses), yielding 105 survey charts for analysis. The
105 responses represent 80.7% of the 130 fully trained
pediatric surgeons currently working in Egypt. A total of
76.2% of responders use both contrast enema and rectal
biopsy for the preoperative diagnosis of HD. Contrast
enema alone is used by 13 (12.4%). A further 11.4%
combine this with anorectal manometry. Intraoperative
frozen section tissue diagnosis is used routinely by only
4.8% of the responders. Surgery is preferred to be
performed during the neonatal period by 21.9% of the
responders, from 1 to 3 months (28.6%), or after the third
month of life (49.5%). A definitive one-stage colonic pullpullthrough
is always used by 59%, whereas 7.6% are still
using staged operations. The rest of the responders had no
specific predilection. The preferred surgical technique for
rectosigmoid HD is transanal endorectal pull-through
(68.5%), Soave transabdominal endorectal pull-through
(19.0%), laparoscopic-assisted pull-through (9.5%), and
Duhamel with GIA staplers (2.9%). The Soave operation is
preferred for HD extending to the right side and total
colonic HD (45.7%) and redo surgery (37.1%).