title: Rehbein's anterior resection in Hirschsprung's disease, using a circular stapler.
abstract: The results of 30 patients with Hirschsprung's disease, operated by Rehbein's anterior resection, have been evaluated. In 26 children the anastomosis was constructed with a circular stapler (Ethicon Proximate ILS) and in 4 it was handsutured. When a stapler was used, technical problems in 4, with a defect in the rings of bowel after firing the instrument, necessitated reinforcing sutures. The level of the anastomosis was significantly lower in the children in which a stapler was used. Eight children were operated by dorsal myectomy (DRM) prior to and 4 after anterior resection. The children with DRM prior to anterior resection had a significantly lower requirement for postoperative dilations. Early postoperative complications included 3.3% mortality, 6.7% enterocolitis, 3.3% anastomotic insufficiency, 3.3% early ileus and 10.0% wound infection. Three patients (10.0%) were operated for postoperative anastomotic stricture, one requiring anastomotic revision and two requiring DRM. At follow-up two children (7.4%) reported constipation with regular requirement for enemas and two (7.4%) reported daily encopresis. Twenty-three patients had 1-5 bowel movements per day and 4 patients had more than 5. In our experience the use of a circular stapler makes it possible to perform a lower anastomosis. We believe that this technique gives a wider and more elastic anastomosis and is technically less difficult to handle than a handsutured anastomosis.
authors.affiliation: Department of Pediatric Surgery, University Children's Hospital, Uppsala, Sweden.
authors.forename: T
authors.initials: T
authors.lastname: Wester
authors.forename: J
authors.initials: J
authors.lastname: Hoehner
authors.forename: L
authors.initials: L
authors.lastname: Olsen
mesh_terms: D000714:Anastomosis, Surgical / Q000295:instrumentation*; D002648:Child; D002675:Child, Preschool; D003082:Colectomy / Q000295:instrumentation; D005260:Female; D005500:Follow-Up Studies; D006627:Hirschsprung Disease / Q000401:mortality / Q000601:surgery*; D006801:Humans; D007223:Infant; D008297:Male; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality / Q000628:therapy; D012086:Reoperation; D013528:Surgical Staplers; D015996:Survival Rate