What is the Swenson procedure for treating Hirschsprung's disease?

The Swenson Procedure for Treating Hirschsprung's Disease

The Swenson procedure is a definitive surgical treatment for Hirschsprung's disease that involves removing the aganglionic segment of colon and creating an anastomosis between normal ganglionic bowel and the rectum just above the dentate line. 1

Surgical Technique

• The Swenson procedure involves full-thickness resection of the aganglionic segment of the colon and a direct anastomosis between the normal ganglionic bowel and the rectum 1, 2
• The procedure can be performed via open surgery or using minimally invasive laparoscopic techniques 3, 4
• During the procedure, the surgeon:
  • Identifies the transition zone between ganglionic and aganglionic bowel (confirmed by intraoperative frozen section) 2
  • Mobilizes the rectum and aganglionic colon 2
  • Performs full-thickness dissection of the rectum down to 0.5-1.0 cm above the dentate line 2
  • Resects the aganglionic segment 2
  • Creates an anastomosis between the normal ganglionic bowel and the rectum 2

Modern Modifications

• Laparoscopic Swenson procedure (LSw) has become increasingly popular as a minimally invasive approach 3, 4
• The transanal Swenson procedure is a newer modification that allows for a completely transanal approach without abdominal incisions 2
• Modified laparoscopic Swenson (MLSw) has shown advantages over other techniques including:
  • Shorter operating time (average 148 minutes vs. 199 minutes for laparoscopic Soave) 4
  • Less blood loss (average 10 mL vs. 26 mL) 4
  • Shorter hospital stay (average 8 days vs. 12 days) 4

Clinical Applications

• The Swenson procedure can be performed as:
  • A primary one-stage procedure in neonates and infants 3, 2
  • A secondary procedure following initial colostomy in more complex cases 3
• It is suitable for both short-segment and long-segment Hirschsprung's disease, including total colonic aganglionosis 3

Outcomes and Complications

• Most patients achieve satisfactory continence after the Swenson procedure, with studies reporting good continence in approximately 80% of patients followed long-term 3, 5
• Potential complications include:
  • Anastomotic leak
  • Enterocolitis (reported in approximately 7% of patients) 3
  • Postoperative ileus (reported in approximately 10% of patients) 3
  • Soiling (reported in 18.5% with modified laparoscopic technique) 4
  • Constipation (reported in 3.7% with modified laparoscopic technique) 4

Postoperative Care

• Patients typically begin oral feeding within 24-48 hours after surgery 3, 2
• Most children return to normal activity within 72 hours 3
• Hospital stays average 4-8 days with modern techniques 3, 4
• Long-term follow-up is essential to monitor for complications and assess bowel function 5

Advantages Over Other Techniques

• The Swenson procedure provides a physiologic repair by removing all aganglionic bowel 1
• Modern laparoscopic modifications have reduced complications while maintaining the benefits of the original procedure 4
• Studies comparing modified laparoscopic Swenson to laparoscopic Soave procedures show lower rates of early postoperative soiling (18.5% vs. 46.7%) and constipation (3.7% vs. 20%) 4

The Swenson procedure remains an important surgical option for Hirschsprung's disease, with modern modifications improving outcomes and reducing complications compared to the original technique.