Posterior sagittal abdominoperineal pull-through: a new approach to definitive treatment of Hirschsprung's disease--initial experience.

PURPOSE: Posterior sagittal abdominoperineal pull-through (PSAPP) was applied for the surgical treatment of Hirschsprung's disease (HD) to decrease the incidence or eliminate the complications related to the major pullthrough procedures.

METHODS

Ten children with HD underwent the new surgical procedure, PSAPR The diagnosis of the disease was established under 1 year of age in 7 children and between 2 and 5 years of age in three instances. The length of resected aganglionic segment ranged from 6 to 20 cm (mean, 11.9 cm). The follow-up period was 18 months to 4 years (mean, 2.7 years). Postoperative clinical and manometric results were compared with children after Rehbein procedure and with controls.

RESULTS

Postoperative complications were observed in patients operated on first: anastomotic stenosis in three children, enterocolitis in three, constipation in two, anastomotic leak (iatrogenic injury) in one, and dehiscence of colostomy anastomosis in two patients. Improved surgical technique allowed to eliminate the causes of complications, and the last five children of this group who underwent surgery have had an uneventful postoperative outcome.

CONCLUSION

The posterior sagittal approach with the posterior anorectotomy provides an excellent exposure of the operative field, allowing to perform the lowest possible resection and subsequent anastomosis.