INTERNAL SPHINCTEROTOMY IN POST-PULL-THROUGH HIRSCHSPRUNGS-DISEASE

Despite proper technique, pull-through operations for Hirschsprung's d isease sometimes fail to deliver normal or effective bowel evacuation. Ten patients, described herein, had had a pull-through procedures. Th e procedures had been performed by various pediatric surgeons. Five ca ses had been diagnosed in the newborn period and had undergone colosto mies. The remainder had been diagnosed later (at 2 months to 2 years o f age). They too had undergone colostomy initially, and all had had an elective pull-through procedure. The techniques varied; two had Soave procedures, seven had Duhamel procedures, and one had a Kimura-Soave procedure (the only case of total colonic Hirschsprung's disease in th e series). All the patients had manifested difficulty in passing stool s after the pull-throughs. The problem was described as ''severe const ipation,'' ''obstipation,'' or ''fecal retention.'' Four patients had been treated with many laxatives, suppositories, enema routines, and d iet regimens for years, with no success. Ail had been examined radiogr aphically to detect megarectum or megacolon. All had had additional bi opsies to confirm the presence of ganglia in the pulled-through segmen ts. At 21 months to 12 years of age, these patients underwent full pos terior internal sphincterotomies. Nine of the 10 had a good or excelle nt outcome, with resolution of the megarectum or megacolon. Three pati ents still require small doses of senna compound, which are being decr eased continuously. Therapy failed for a patient with Down's syndrome and a Duhamel pull-through, and a stoma was required. Copyright (C) 19 96 by W.B. Saunders Company