A 2-day-old male neonate fails to pass meconium. Contrast enema shows a transition zone at the rectosigmoid junction. Suction rectal biopsy confirms absence of ganglion cells in the Auerbach plexus. This is consistent with Hirschsprung disease. The definitive surgical procedure performed in the neonatal period is:

• A Hartmann's procedure with later reversal
• B Levelling colostomy followed by pull-through at 6 months
• C Primary pull-through (Swenson, Soave, or Duhamel operation) ✓
• D Myomectomy of the internal anal sphincter

Explanation

Primary pull-through without a staged colostomy is now standard for uncomplicated neonatal Hirschsprung disease. The three main techniques are Swenson (rectosigmoid resection with low colorectal anastomosis), Soave (endorectal pull-through, retaining muscular cuff), and Duhamel (retrorectal pull-through creating a side-to-side anastomosis). Staged procedures with initial colostomy are reserved for enterocolitis, perforation, or delayed diagnosis with significant dilation.

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.