Rehbein procedure for secondary megacolon in children

Abstract

To evaluate the results of Rehbein procedure with extraperitoneal colorectal anastomosis combined with complex conservative treatment in children with secondary megacolon due to chronic constipation. We carried out surgical interventions in 78 children aged 7-12 years with chronic colostasis resistant to conservative treatment. All patients underwent clinical, laboratory and instrumental examination. All patients were divided into 3 groups depending on type of surgery: group I - colon resection followed by intraperitoneal colorectal anastomosis (28 patients), group II - open Rehbein procedure (29 patients), group III - laparoscopic Rehbein procedure (21 patients). Absence of dyspeptic disorders and enterocolitis in remote postoperative period in patients receiving comprehensive treatment enhanced with new additions is the cause of improved outcomes. Type of surgery should be individualized in view of anatomical colon changes and secondary pathological conditions. Some pathological symptoms observed at preoperative period may be recurrent in long-term postoperative period due to wrong selection of surgery. The risk of recurrent chronic constipation is high after colon resection followed by intraperitoneal colorectal anastomosis. Rehbein procedure may be preferred for management of secondary megarectum and megasigma. Laparoscopic technique reduces surgical trauma and requires less postoperative analgesia.