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

Purpose: The authors describe their newly developed technique-primary trans anal rectosigmoidectomy for Hirschsprung's disease (HD) and its preliminary results in neonates and infants, Methods: Thirty-four consecutive patients (26 boys) with biopsy-proven rect osigmoid HID, 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 proxi mal to the dentate line. The rectal muscular sleeve below the peritoneal re flection was resected to the level of the striated muscle complex, leaving a shorter muscular cuff, into which a partial internal sphincterotomy was m ade posteriorly. An oblique anastomosis was constructed between the pull-th rough ganglionic colon and the anus canal. Results: The mean time for the operation was 160 minutes, and the average l ength 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 mye ctomy, Eighty-four percent of patients had 1 to 6 bowel movements per day d uring a 6- to 18-month follow-up period. Conclusions: Primary transanal rectosigmoidectomy for HD is logical and ass ociated with excellent early results. A longterm follow-up is required to d etermine bowel functions. Copyright (C) 2001 by WB. Saunders Company.