RESUMEN
Since Hirschsprung s disease is- a complicated and frightful congenital anomaly to the parents, every effort should be taken to reach the optimal result that is beneficial to the patient, parents and surgeon also. Its incidence is 1; 5000, more common in male. The principle for treatment by Rehbien s procedure is to remove the agangilonic narrow segment including the dilated sigmoid colon by dissection of the upper rectum deep down into the pelvic cavity about 2 cm from peritoneal reflection and to elimination of achalasia of internal anal sphincter by vigorous dilatation. Assessment of the advantage of the Rehbein procedure in treatment of Hirschsprung disease. 50 cases [44 male and 6 female] with Hirschsprung s disease presented with positive history of delayed passing meconium, clinical symptoms and Ba-enema [different level of narrow segment] treated by Rehbien s procedure are presented at central teaching hospital for pediatrics between Aug 1998-april 2005 In children failed to thrive, colostomy was performed until their development had progressed well and corresponding to their age Rehbien s procedure was done primarily in 44 cases at the age of 2 months to 3.5 years [88%]. Children who were well corresponding to their age were treated with abdominal resection plus protective loop transverse colostomy at the same time 6 cases [12%]. 39 cases classified as very good [78%]; 8 cases classified as good [16%]; 3 cases classified as satisfactory or unsatisfactory [6%]; No disorders of urinary evacuation such as retention or incontinence were seen. We never observed anal incontinence. In 12 cases[24%], an anastomotic line stenosis was treated by Hegars dilator under general anesthesia and continued at home by the family, No anastomotic leak was found. 8 cases[16%] needed frequent anal dilatation under general anesthesia at intervals. 1 case needed sphincter'otomy. Hirschsprung disease is not an uncommon disease. Its treatment needs experience and surgery can have uncorrectable complications. I found that this procedure is efficient, easy to perform, and less time- consuming and carries few complications and finally keeps good relation with the families of the children
RESUMEN
Anorectal malformation is a congenital anomaly of different varieties and its correction needs good experience, knowledge about this varieties and specific surgical tools, otherwise the child may lose his the only chance to live normally without disastrous complication like incontinence. assessment of the advantage of this procedure in management of anorectal malformations and the percentage for anal continence. This study was carried out in the child's central teaching hospital in Baghdad total number [70] cases were included in the study, 37 males and 33 females: aged 7 days to 6 years. They attended the hospital between October 1998-october 2004.* Male defect included: 1] Low type....5 cases No colostomy needed. 2] Intermediate type....23 cases, needed colostomy. 3] High type.... 9 cases needed colostomy. Female defects: 1] Imperforate anus with vestibular fistula-31 cases. 2] Imperforate anus without fistula 2 cases. From the study we gain the following results- all the male patients with low and intermediate types 28 cases [40%] show 100% continence. All female patients with imperforated anus with vestibular fistula and without fistula 33 cases [47%] show 100% continence. The combination of male and female patients show 61 patients of 70 show 100%continence in a percentage of 87%. The nine cases [12.85%] with recto bladder neck fistula show poor continence due to their bad sacral contour associated with the poor development of pelvic muscles sphincter. This result was revealed from follow-up together with the presence of external sphincter muscle contraction which occurs during digital PR examination or by the use of surgical dilators. From the study we found that this procedure gives high percentage of continence and should be used instead of other procedures