Modified soave pull-through for Hirschsprung's disease: intraoperative internal sphincterotomy.
OBJECTIVE
Anorectal achalasia (AA) may persist after pull-through (PT) for Hirschsprung's disease (HD), which may cause postoperative enterocolitis (POE) and constipation. The authors modified the Soave PT (modified Soave PT, MSPT) to eliminate AA, and present their results.


METHODS
This was a 16-year retrospective review of 43 patients with histologically proven HD of the rectosigmoid or sigmoid colon treated by MSPT. The MSPT involves excision of the posterior rectal cuff and an intraoperative internal sphincterotomy, allowing the PT colon to fit nicely.


RESULTS
Mean age at MSPT was 16.7 months (16 were < or =3 months old [37%]; 7 were neonates [16%]). Mean follow-up was 9.2 years. Six of 43 cases (14%) had preoperative enterocolitis; only 2 of 43 (5%) had single episodes of POE. At review, 37 of 43 were older than 4 years; 29 (78%) had normal bowel function (14 had experienced soiling after MSPT, which resolved after a mean of 6.4 years); and 8 (21%) had problematic bowel function: 3 had occasional soiling, 1 had soiling only before defecation, 3 (8%) had constipation requiring laxatives or enemas, and 1 had significant soiling.


CONCLUSIONS
MSPT is safe and may contribute to a reduction in the incidence of POE and constipation.
Miyano
T
T
Department of Pediatric Surgery, Juntendo University School of Medicine, Tokyo, Japan.
Yamataka
A
A
Urao
M
M
Kobayashi
H
H
Lane
G J
GJ
D013505:Digestive System Surgical Procedures / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006627:Hirschsprung Disease / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D012189:Retrospective Studies; D016717:Sphincterotomy, Endoscopic / Q000379:methods*; D016896:Treatment Outcome