One stage transanal endorectal pull through in postanorectal myectomy hirschsprung's disease

ABSTRACT

Despite proper technique and more than 3 decades of experience, most pediatric surgeons have found that the results of anorectal myectomy as a definitive treatment of short segment Hirschsprung's disease were disappointing. In the present series 15 children [9 males and 6 females] with a mean of 4.3 years were evaluated for persistent constipation following anorectal myectomy for short segment Hirschsprung's disease. 13 children were managed by one stage transanal endorectal pull through procedure, with a follow up period of 12 to 20 months. The cosmetic results were excellent in all patients with no major complications and a bowel habit of at least once per day. Soiling was only troublesome in one child. The present series shows that anorectal myectomy is not a suitable definitive treatment of short segment Hirschsprung's disese because even if it reaches a ganglionic level the inertic dilated rectum persists with persistent constipation. It also shows that one stage transanal endorectal pull through is the best primary treatment of short segment Hirschsprung's disease and as a redo procedure for failed anorectal myectomy