Limited Surgery for Lower-Segment Hirschsprung's Disease

Objective: To determine if rectal myectomy is an effective treatment for a specific group of patients with Hirschsprung's disease. Design: Retrospective series with follow-up of 6 to 132 months (mean follow-up, 37.1 months). Setting: Children's hospital. Patients: Fourteen children aged 2 to 14 years with chronic constipation and nondiagnostic barium enema contrast study findings. Intervention: Posterior rectal myectomy. Main Outcome Measures: Laxative use, frequency of stools, incidence of soiling or incontinence, and patient's assessment of improvement. Results: The conditions of all 14 patients improved regardless of the presence of ganglion cells in the myectomy specimen; there were six excellent, six good, and two fair assessments. Laxatives were used intermittently by seven of 14 patients. No patients complained of incontinence or soiling. Conclusions: Rectal myectomy is an effective, less-extensive operation that should be considered for older children with Hirschsprung's disease. (Arch Surg. 1994;129:920-925)