Enfermedad de Hirschsprung, Conclusiones

En la Enfermedad de Hirschsprung la patogenia específica aún no se ha aclarado; pero los progresos en el conocimiento de las alteraciones de motilidad intestinal, hormonas gastrointestinales, y métodos de estudio como la manometría e histoquímicos.

Ayudan a determinar y definir, en forma precoz, un diagnóstico exacto, el cual debe hacerse de preferencia durante el período de recién nacido.

Un diagnóstico oportuno, evita complicaciones como la enterocolitis. de alta mortalidad, y permite una cirugía definitiva adecuada con magníficos resultados a largo plazo, en especial con el empleo de las suturas mecánicas gastrointestinales, evitando así el alto índice de complicaciones postoperatorias; pues los múltiples procedimientos y variadas modificaciones de intervenciones quirúrgicas nos deben alertar de lo inadecuado; solo la experiencia y prejuicios de los cirujanos influyen en la elección del tipo conveniente de cirugía, dependiendo de la facilidad y seguridad con que se pueda realizar, se lograrán buenos resultados.

Un completo seguimiento postoperatorio no es posible. porque muchos pacientes y sus parientes cambian con frecuencia el lugar de residencia y no pueden ser localizados; otros no se sienten satisfechos con su operación, y a menudo van donde otro cirujano.

Se consideran con excelentes resultados quienes defecan normalmente, retienen líquidos y gases, y se sienten bien; algunos presentan movimientos acuosos, nocturnos, por algunos años; persistencia de estreñimiento (5%) con evacuaciones duras, cada 4 a 6 días, que pueden corregirse con laxantes, enemas o supositorios ocasionales, responden bien después de algún período de tiempo prolongado.

El conocimiento de factores etiológicos posiblemente ayuden a modificar el criterio, y se instituya. incluso. una prevención prenatal de esta enfermedad.

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