The results of patients operated due to congenital megacolon are a single-centered experience

Objective: The aim of this study was to examine the data of patients operated for congenital megacolon and evaluate the relationship between postoperative complications and surgical techniques. Patients and Methods: Data from 131 patients with Hirschsprung's disease treated at our clinic between January 1, 2010, and September 30, 2024, were retrospectively analyzed. The study investigated the patients' diagnostic and surgical ages, gender distribution, presenting complaints, family history, delayed passage of meconium, comorbidities, level and length of the aganglionic segment, surgical approaches, surgical techniques applied, stoma creation, duration of surgery, number of surgical stages, and preoperative episodes of enterocolitis, and risk factors. Postoperative early and late complications, the need for redo surgeries and their reasons, as well as radiological findings, were comprehensively analyzed. The data obtained were compared between groups. Additionally, two separate analyses were conducted in the study: one focusing solely on patients with left colon involvement and another encompassing all patients. These analyses evaluated whether risk factors predicted long-term outcomes such as preoperative enterocolitis, postoperative enterocolitis, postoperative stricture, and the need for redo surgery. Results: The average age at diagnosis was 17.5 months, and the mean age at definitive surgery was 31.2 months. The most frequent diagnosis was made in the neonatal period (39.7%), followed by the age group of 24 months and older (16.8%). The most common presenting complaint was constipation (50%), followed by ileus (20%) and abdominal distension (16%). Delayed meconium passage (>24 hours) was recorded in 22% of the patients. The rate of comorbidities was 24.4%, with Trisomy 21 being the most common (7%). Surgical techniques included Transanal Endorectal Pull-Through (TERPT) (41%), the Swenson procedure (38%), the Soave-Boley procedure (15%), and the Duhamel-Martin procedure (6%). Among surgical approaches, the transabdominal approach was used in 38%, the transanal method in 32%, and laparoscopy-assisted transanal surgery in 30%. Early complications were observed in 17.1% of patients, with anastomotic leakage (4.7%) and ileus (4.7%) being the most common. Long-term complications included constipation (32.8%), fecal incontinence (29%), stricture (24.4%), and dermatitis (18.3%). Higher rates of complications were observed in the Duhamel-Martin and Soave-Boley groups. The need for redo surgery was identified in 9.9% of cases, with anastomotic leakage being the most common cause. Conclusion: The analyses provided a comprehensive evaluation of the diagnostic, surgical, and complication processes in patients with congenital megacolon. Detailed assessments of the most common presenting complaints and surgical methods were conducted, with early and long-term complications thoroughly analyzed. Particular emphasis was placed on factors such as postoperative stricture and growth delay in relation to the need for redo surgery. Furthermore, significant differences and risk factors among surgical approaches were identified. The study's findings offer important guidance for the management and treatment of Hirschsprung's disease, contributing to future clinical applications.