Surgical treatment for Hirschsprung’s Disease: An ERNICA animation for parents and families

This animation aims to provide you with more information about surgical treatment for Hirshsprung's disease. This disease is also known as a ganglionosis of the colon. After a diagnosis of Hirschprung's disease is confirmed, surgery can be planned to remove the affected part of the bowel. Surgical removal of the affected part is usually performed 2 to 3 months after diagnosis, when the baby is strong enough and growing well. And there are no signs of enterocolitis, which is inflammation of the bowel. This surgery is performed in the operating room with the baby under general anesthetic. The aim of this surgery is to remove the ganglionic bowel, which is the affected part of the bowel with no ganglion cells present. The transition zone should also be removed, which is the area of the bowel between the ganglionic part and the part containing a normal amount of ganglion cells, which is called the ganglionic bowel. Then the remaining part of the bowel is connected to the anal canal. This is called a pull through, and it helps to restore the movement of feces or poop. During the operation, tissue samples can be taken to confirm the presence of ganglion cells. This surgical procedure can be performed in different ways. It used to be done by open surgery, which is when a large incision in the outside skin is made. Nowadays, when possible, the procedure is done transanally, which is via the anal canal, sometimes assisted by laparoscopy, which is when a small camera is inserted through the skin and small incisions are made. There are also different pull through techniques, such as the transanal pull through technique and the Swenson, Duhamel, and suave procedures. The surgical techniques used depend on the child, the length of the affected bowel area, the surgeon's preference, and hospital resources. Whichever technique is used, preservation of the anal canal is crucial in order to maintain continence. After surgery, it is important that the new connection between the bowel and anal canal is unobstructed, and that surgical wounds heal well. Although surgery can help to relieve symptoms, your developing baby may experience ongoing difficulties that require different types and levels of care. Difficulties may include constipation, which is when it is difficult to pass feces and a lack of control over bowel movements. Sometimes support with bowel management is necessary. After surgery, individuals with Hirschprung's disease may also remain prone to bowel infections, known as enterocolitis. In these cases, it will be necessary to seek professional medical advice. Structured regular follow-up care by a team of different clinical specialists is essential for babies with Hirschsprung's disease, ideally by a multidisciplinary team, or MDT. Identifying any complications or difficulties early is very important. Even if your child has symptoms after corrective surgery, these can improve as they grow older. Peer support can be accessed through patient and family support groups.