What are the current guidelines for the surgical management of Hirschsprung's disease in paediatric patients?

Current guidelines for the surgical management of Hirschsprung's disease in paediatric patients focus primarily on appropriate diagnosis and referral rather than detailed surgical techniques within primary care settings.

Children suspected of having Hirschsprung's disease—indicated by clinical features such as delayed passage of meconium beyond 48 hours in term babies, constipation since the first few weeks of life, chronic abdominal distension with vomiting, family history of Hirschsprung's disease, or faltering growth—should be urgently referred to a specialist healthcare professional competent in performing and interpreting a digital rectal examination and other diagnostic procedures.

Rectal biopsy, the definitive diagnostic test for Hirschsprung's disease, should only be performed if these clinical features are present.

Once diagnosed, children with unresolved symptoms despite optimum medical management should be referred to a paediatric surgical centre for assessment of suitability for surgical interventions such as the antegrade colonic enema (ACE) procedure.

Post-surgical care includes ensuring access to specialist paediatric healthcare professionals for support, information, and follow-up.

Specific surgical techniques and detailed operative management are typically managed within specialist paediatric surgical centres and are not detailed in the primary care guidelines.

This approach ensures timely diagnosis, appropriate referral, and coordinated surgical management by specialists experienced in Hirschsprung's disease.

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