A MODIFIED OPERATION FOR HIRSCHSPRUNGS-DISEASE - POSTERIOR LONGITUDINAL ANORECTAL SPLIT WITH A HEART-SHAPED ANASTOMOSIS

A variety of complications can arise after the definitive pull-through operation for Hirschsprung's disease. Among these are constipation an d soiling, which may be due to mismanagement of the internal anal sphi ncter. In order to prevent these complications, we developed an improv ed operative procedure based on preservation of the anterior anorectum that utilizes a posterior longitudinal split with an oblique anastomo sis. Forty patients underwent this procedure over a 4-year period; ade quate follow-up was obtained in 34 cases. Mean age at operation was 13 months (range 3 months to 7 years). A primary pull-through without a colostomy was performed in 38 of the 40 patients. The results showed e xcellent preservation of function, with a mean follow-up of 5 years an d 7 months. There was no occurrence of spastic stenosis of the interna l sphincter, no incontinence, and minimal constipation or soiling.