The absorptive function of colonic aganglionic intestine: are the Duhamel and Martin procedures rational?

The Lester Martin modification of the Duhamel procedure is an accepted definitive operation for long-segment Hirschsprung's disease, in which considerable use is made of aganglionic bowel. Whether the aganglionic segment contributes to fluid and electrolyte reabsorption is not known. We have modified the technique of nonequilibrium dialysis of the rectum in order to obtain simultaneous measurements of electrolyte transport and transmural potential difference (PD) in 9 infants with Hirschsprung's disease (HD), prior to operation. Six age-matched infants were studied as controls. In the control group Na+ was absorbed electrogenically while K+ secretion was passive and greater than HCO3- secretion. In HD, both NA+ absorption and Cl- absorption were greater than in control children, with Cl- absorption exceeding Na+ absorption. PD was higher in HD infants than in controls, with an associated increase in K+ secretion. HCO3- secretion accounted for the difference between Na+ and Cl- absorption. These data clearly show that aganglionic colon transports electrolytes, and that in the Lester Martin modification of the Duhamel procedure the refashioned colorectum contributes to overall colonic salvage of electrolytes.