A modified operation for Hirschsprung's disease: Posterior longitudinal anorectal split with a “heart-shaped” anastomosis

Abstract

A variety of complications can arise after the definitive pull-through operation for Hirschsprung's disease. Among these are constipation and soiling, which may be due to mismanagement of the internal anal sphincter. In order to prevent these complications, we developed an improved operative procedure based on preservation of the anterior anorectum that utilizes a posterior longitudinal split with an oblique anastomosis. Forty patients underwent this procedure over a 4-year period; adequate follow-up was obtained in 34 cases. Mean age at operation was 13 months (range 3 months to 7 years). A primary pull-through without a colostomy was performed in 38 of the 40 patients. The results showed excellent preservation of function, with a mean follow-up of 5 years and 7 months. There was no occurrence of spastic stenosis of the internal sphincter, no incontinence, and minimal constipation or soiling.

Association between outpatient examinations and upgrading treatments for pediatric constipation

“…Patients with constipation is of about 30% of total patients in pediatric gastrointestinal clinics [11], while in our outpatient department which has been set over 30 years [12][13][14][15], about 500 to 700 children with constipation are referred to or come to visit our department every year. The current study, which contains the largest population of pediatric constipation, aimed to use the real-world data to validate the ndings of assistant examinations for diagnosing constipation and directing the treatment for children with constipation.…”