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KMID : 0371319680100060421
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Journal of the Korean Surgical Society
1968 Volume.10 No. 6 p.421 ~ p.426
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Surgical Treatment of Congenital Megacolon
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李世淳/Lee, S.S.
金光洙/趙範九/崔厦景/徐相賢/洪弼勳/Kim, G.S./Cho, B.K./Choi, H.K./Suh, S.H./Hong, P.W.
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Abstract
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Definitive surgery for congenital megacolon, Hirschsprung´s disease, being one of the commoner and more lethal form of intestinal obstruction in infancy, was described by Swenson and Bill in 1948 on the basis of animal experiments; consisting of abdominoperineal resection of the aganglionic rectum and sigmoid colon with primary anastomosis. Subsequeutly, this procedure became known as the "pull-through," or Swenson´s operation, and gained acceptance as a standard radical operation for a histologically benign condition and as a great contribution to pediatric surgery.
It is, nevertheless, a delicate and difficult operation to perform and yields reasonably satisfactory results only when performed by an experienced and careful surgeon. There are serious complications due to complete removal of the rectum by pelvic dissection and to the retroperitoneal suture line. Dissatisfaction with the Swenson´s procedure, by competent surgeons, led to various modifications, which include Hiatt´s intussusception operation, rectosigmoid myotomy (similar to the Ramstedt and the Heller´s operation), anterior abdominal resection (State and Rehbein´s operation.) However, they represent a compromise type of operation since they leave the aganglionic rectum undisturbed and accept a certain amount of residual symptoms of Hirschsprung´s disease. In 1957, Duhamel presented a simple modifiation of the Swenson´s procedure, which left the rectum intact, and established an end-to-side anastomosis with the normal colon (or ileum) by rectorectal pull-through.
To prevent two theoretical objections to the original Duhamel´s operation, Grobadvocated incision on the posterior rectal wall immediately above the internal sphincter, instead of the lower incision sacrifing the anus; and Louw made a short rectal pouch, acting as a blind pouch if longer than 3cm in length; Martin, a complete division of the rectocolic septum with spur crushing clamp; and Sieber, a triangular wedge resection of the septum to produce a common ampulla.
Satisfactory results without any serious complication in 5 children (four males and one female) with Hirschsprung´s disease have followed modified Duhamel´s operation as a 3-stage procedure in Severance Hospital. This shows that the procedure is safe with less dissection and much less shock than the Swenson´s procedure, and should be a reasonably satisfactory operation for Hirschsprung´s disease.
Some of the technical problems in the management of Hirschsprung´s disease by this procedure are discussed, along with the advantage of multiple stage.
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