Primary transanal rectosigmoidectomy for Hirschsprung's disease: Preliminary results in the initial 33 cases

Abstract

Purpose: The authors describe their newly developed technique—primary transanal rectosigmoidectomy for Hirschsprung's disease (HD) and its preliminary results in neonates and infants. Methods: Thirty-four consecutive patients (26 boys) with biopsy-proven rectosigmoid HD, aged 18 days to 4 years, underwent this new procedure. Rectal mucosectomy started 1 to 1.5 cm posteriorly and 2 to 3 cm anteriorly proximal to the dentate line. The rectal muscular sleeve below the peritoneal reflection was resected to the level of the striated muscle complex, leaving a shorter muscular cuff, into which a partial internal sphincterotomy was made posteriorly. An oblique anastomosis was constructed between the pull-through ganglionic colon and the anus canal. Results: The mean time for the operation was 160 minutes, and the average length of bowel resected was 29.5 cm (range, 12.5 to 41 cm). Two children (6.06%, 2 of 33) had 2 to 5 episodes of postoperative enterocolitis (EC). One was cured by rectal irrigation and dilation, and the another by Lynn's myectomy. Eighty-four percent of patients had 1 to 6 bowel movements per day during a 6- to 18-month follow-up period. Conclusions: Primary transanal rectosigmoidectomy for HD is logical and associated with excellent early results. A long-term follow-up is required to determine bowel functions. J Pediatr Surg 36:1816-1819. Copyright © 2001 by W.B. Saunders Company.