A 2-day-old neonate has failure to pass meconium and progressive abdominal distension. X-ray shows multiple dilated bowel loops. Contrast enema reveals a transition zone at the rectosigmoid junction. Rectal suction biopsy confirms absence of ganglion cells. The definitive surgical procedure performed typically at 3–6 months is:

• A Duhamel (retrorectal pull-through) procedure
• B Swenson (rectosigmoidectomy and anastomosis) procedure
• C All three are acceptable; current preferred approach is laparoscopic Swenson or Soave ✓
• D Soave (endorectal pull-through) procedure

Explanation

The three classic procedures for Hirschsprung disease — Swenson (extramucosal rectosigmoidectomy with coloanal anastomosis), Soave (endorectal pull-through preserving the rectal muscular cuff), and Duhamel (retrorectal pull-through with side-to-side anastomosis) — are all accepted surgical options with similar long-term outcomes. The current trend favors laparoscopic-assisted pull-through (Swenson or Soave technique), often performed as a primary procedure in the neonatal period without a defunctioning colostomy. No single technique has proven superiority for all cases.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.