A modified operation for Hirschsprung's disease: Posterior longitudinal anorectal split with a “heart-shaped” anastomosis

A variety of complications can arise after the definitive pull-through operation for Hirschsprung's disease. Among these are constipation and soiling, which may be due to mismanagement of the internal anal sphincter. In order to prevent these complications, we developed an improved operative procedure based on preservation of the anterior anorectum that utilizes a posterior longitudinal split with an oblique anastomosis. Forty patients underwent this procedure over a 4-year period; adequate follow-up was obtained in 34 cases. Mean age at operation was 13 months (range 3 months to 7 years). A primary pull-through without a colostomy was performed in 38 of the 40 patients. The results showed excellent preservation of function, with a mean follow-up of 5 years and 7 months. There was no occurrence of spastic stenosis of the internal sphincter, no incontinence, and minimal constipation or soiling.