Preoperatively, counsel the family as to the available surgical options. If the child is to undergo a staged procedure or have a permanent ostomy, provide preliminary instruction about ostomy care to the family. Outpatient dilations may be necessary to alleviate strictures. Postoperative complications may include intermittent fecal soiling and incontinence, anastomotic leak, stricture formation, intestinal obstruction, and enterocolitis. The outcome in infants and children with Hirschsprung disease is generally quite good.
Most children obtain fecal continence and control.
However, children with Down syndrome may be expected to have lower rates of continence, and some authors support placement of a permanent ostomy. When applicable, teach patients and their families how to care for an ostomy. Also consider this disease in infants and children with chronic constipation that is refractory to treatment. Infants who lack ganglion cells throughout their entire colons are said to have total aganglionosis coli. Early diagnosis and prompt surgical care are essential to prevent serious complications as enterocolitis.