Orvar Swenson, the same man who discovered the cause of Hirschsprung’s, first performed it in 1948. The pull-through procedure repairs the colon by connecting the functioning portion of the bowel to the anus. The pull through procedure is the typical method for treating Hirschsprung’s in younger patients. Swenson devised the original procedure, but the pull-through surgery has been modified many times.
The Swenson, Soave, Duhamel, and Boley procedures all vary slightly from each other:
- The Swenson procedure leaves a small portion of the diseased bowel.
- The Soave procedure leaves the outer wall of the colon unaltered. The Boley procedure is just a small modification of the Soave procedure. The term “Soave-Boley” procedure is sometimes used.
- The Duhamel procedure uses a surgical stapler to connect the good and bad bowel.
Of those 15% of children who do not obtain full control, various other treatments are available. If constipation is the problem then usually laxatives or a high fiber diet will overcome the problem. If lack of control is the problem then a stomamay be necessary. The ACE or Malone is also an answer. This is where a tube goes through the abdominal wall to the appendix, or if available, to the colon. Then once a day the bowel is flushed. Children as young as 6 do fine with administering this on their own.
If the affected portion of the lower intestine is restricted to the lower portion of the rectum, other surgical procedures, such as the posterior rectal myectomy, can be performed.