Iraqi experience of performing Rehbein s procedure as a surgical treatment of Hirschsprung S disease at central child hospital

ABSTRACT

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