Proximal segment histology of resected bowel in Hirschsprung's disease predicts postoperative bowel function

The authors present an overview pf 101 patients operated for Hirschsprung's disease by Rehbein procedure. Special attention is directed to the histomo rphological findings in the proximal segment of the resected bowel specimen s. A strong link was confirmed between these specific features and postoper ative bowel function. A histologically regular proximal bower segment gener ally predicted good postoperative bowel function with a constipation rate o f 10.5%. In patients with intestinal neuronal dysplasia (IND) of the proxim al segment the overall clinical result remained unchanged, although the con stipation rate rose to 17.8%. Postoperative bowel function was seriously af fected in cases characterized by proximal segment hypoganglionosis with a c onstipation rate of 23.1% and an additional 7.7% with encopresis. Finally, the distinct group of children with aganglionosis of the proximal segment f ollowed a complicated postoperative course with secondary bower resections and recurrent episodes of enterocolitis. In addition, the authors state the ir general observation that histological findings become less important whe never a more extensive resection than left hemicolectomy is required. Discu ssing the results, guidelines are given to further patient treatment once t he particular proximal segment histology is diagnosed.