The treatment of the ultrashort forms of Hirshprung’s disease in children

Abstract

The aim of the study was to estimate the efficacy of sphincterotomy in patients with the rectal forms of Hirshprung’s disease with ultrashort aganglionic segment. Methods. From 1991 to 2015, 203 children with persistent chronic constipation, receiving conservative therapy were observed in our pediatric surgery departments. Confirmed positive effect was not possible despite of the complex conservative therapy. The inspection included X-ray examinations, prophylometry, rectal biopsy by Swenson. Prophylometry revealed hypertone of the anal canal and sphincters in all patients. By the histology data, agangliosis the same was found in all patients and the diagnosis of Hirshprung’s disease, ultrashort aganglionic segment was positioned. For the treatment of these patients were used two methods of surgical intervention: Lynn`s operation from 119 patients (58,6%) and posterior myectomy at 84 patients (41,4%). Results. Next outcomes were evaluated through 3 months in all patients. After the Lynn`s operation good result was in 34% of patients, a satisfactory- 34%, unsatisfactory result-32% of patients. In patients operated using the posterior myectomy, a good result was 29,8% of patients, a satisfactory-53,6%, unsatisfactory result-16,6% of patients. All patients was carried out step-wise rehabilitation therapy. Long-term outcomes were evaluated through 12 months in all patients. After the Lynn`s operation good result was in 55% of patients, a satisfactory-45%, unsatisfactory results were not. In patients operated using the posterior myectomy, a good result was 29,8% of patients, a satisfactory-53,6%, unsatisfactory result-16,6% of patients. Conclusion. In the dynamics of the greatly increased number of patients with good and satisfactory results at the expense of poor results, especially in the group after Lynn`s operation. Consequently, the Lynn’s operation showed greater effectiveness for treatment of children with ultrashort form of Hirschsprung’s disease.