Surgery

Surgery to bypass the part of the colon that has no nerve cells treats Hirschsprung's disease. The lining of the diseased part of the colon is stripped away, and normal colon is pulled through the colon from the inside and attached to the anus. This is usually done using minimally invasive (laparoscopic) methods, operating through the anus.

In children who are very ill, surgery might be done in two steps.

First, the abnormal portion of the colon is removed and the top, healthy portion of the colon is connected to an opening the surgeon creates in the child's abdomen. Stool then leaves the body through the opening into a bag that attaches to the end of the intestine that protrudes through the hole in the abdomen (stoma). This allows time for the lower part of the colon to heal.

Ostomy procedures include:

• Ileostomy. The doctor removes the entire colon and connects the small intestine to the stoma. Stool leaves the body through the stoma into a bag.
• Colostomy. The doctor leaves part of the colon intact and connects it to the stoma. Stool leaves the body through the end of the large intestine.

Later, the doctor closes the stoma and connects the healthy portion of the intestine to the rectum or anus.

Results of surgery

After surgery, most children pass stool normally — although some may have diarrhea at first.

Toilet training may take longer because children have to learn how to coordinate the muscles used to pass stool. Long term, it's possible to have continued constipation, a swollen belly and leaking of stool (soiling).

Children continue to be at risk of developing a bowel infection (enterocolitis) after surgery, especially in the first year. Be aware of signs and symptoms of enterocolitis, and call the doctor immediately if any of these occur:

• Bleeding from the rectum
• Diarrhea
• Fever
• Swollen abdomen
• Vomiting