possible. Frozen section biopsy was

possible. Frozen section biopsy was not consistently available during the period and level of resection is from a combination of barium studies’ report, visualization of the transition zone and frozen section when available.

All anastomoses are either covered with a caecostomy tube using size 24-26 Foley’s catheter or well lubricated 2-cc syringe inserted into the anus beyond the anastomosis which is removed on the fifth postoperative day. A gentle rectal examination to assess the anastomosis is done on the 10th day unless there is evidence of peritonitis. During follow-up, the parents were asked about the pattern of bowel motion, presence of continuous soiling and straining at defecation. The older children were also asked about rectal sensation as well as soiling.


RESULTS
There were 33 children managed with Swenson operations during the period, of which 28 were males and five were females (M 5.6: F = 1). The median age at presentation was eight months (range three days to 11 years). The clinical presentation in the patients was as shown in Table 1. Chronic constipation and abdominal distension were the commonest presentations. Despite the late presentation a history of delayed passage of meconium in the neonatal period was obtainable in 20 (60.6%) of the patients. All the patients had features of intestinal obstruction on plain abdominal X-rays while one neonate with caecal perforation had free intraperitoneal gas. Barium enema was done on nine patients and classically demonstrated the transition zone.
Fifteen (45.5%) patients had colostomy prior to the pullthrough. Eleven (73.3%) of the colostomies were sited in the sigmoid colon and the remaining four (26.7%) in the right transverse colon. Nine (60%) of the colostomies were divided while six (40%) were loop colostomy. The median age at formation of colostomy was six months (three days to 11 years). Major complications of prolapse and wound breakdown occurred in four (26.7%) and two (13.3%) of the patients with colostomy respectively. A patient had non-functioning stoma because it was sited blindly in an aganglionic segment. This required refashioning of the stoma to a more proximal level. The duration of the colostomy before definitive pull-through varied from one to 18 months with a median duration of four months.