Rehbein's anterior resection in Hirschsprung's disease, using a circular stapler

Eur J Pediatr Surg. 1995 Dec;5(6):358-62. doi: 10.1055/s-2008-1066243.

Abstract

The results of 30 patients with Hirschsprung's disease, operated by Rehbein's anterior resection, have been evaluated. In 26 children the anastomosis was constructed with a circular stapler (Ethicon Proximate ILS) and in 4 it was handsutured. When a stapler was used, technical problems in 4, with a defect in the rings of bowel after firing the instrument, necessitated reinforcing sutures. The level of the anastomosis was significantly lower in the children in which a stapler was used. Eight children were operated by dorsal myectomy (DRM) prior to and 4 after anterior resection. The children with DRM prior to anterior resection had a significantly lower requirement for postoperative dilations. Early postoperative complications included 3.3% mortality, 6.7% enterocolitis, 3.3% anastomotic insufficiency, 3.3% early ileus and 10.0% wound infection. Three patients (10.0%) were operated for postoperative anastomotic stricture, one requiring anastomotic revision and two requiring DRM. At follow-up two children (7.4%) reported constipation with regular requirement for enemas and two (7.4%) reported daily encopresis. Twenty-three patients had 1-5 bowel movements per day and 4 patients had more than 5. In our experience the use of a circular stapler makes it possible to perform a lower anastomosis. We believe that this technique gives a wider and more elastic anastomosis and is technically less difficult to handle than a handsutured anastomosis.

MeSH terms

  • Anastomosis, Surgical / instrumentation*
  • Child
  • Child, Preschool
  • Colectomy / instrumentation
  • Female
  • Follow-Up Studies
  • Hirschsprung Disease / mortality
  • Hirschsprung Disease / surgery*
  • Humans
  • Infant
  • Male
  • Postoperative Complications / etiology
  • Postoperative Complications / mortality
  • Postoperative Complications / therapy
  • Reoperation
  • Surgical Staplers*
  • Survival Rate