Transanal endorectal coloanal anastomosis for Hirschsprung's disease

In adults, transanal endorectal colo- or ileoanal anastomosis has recently been advocated for low rectal malignancies and restorative proctocolectomy in ulcerative colitis and familial polyposis. Since 1987, we have used this approach in 20 patients for operative correction of Hirschsprung's disease. In 13 patients the definitive operation was performed before the age of 6 months. A rectosigmoidectomy to the undilated colon was performed transabdominally. The rectum was dissected caudally to the upper border of the levator muscles. Mucosal proctectomy was performed transanally beginning 3–5 mm above the pectinate line. The submucosal dissection extended proximally for a distance of 5 cm. The rectum was excised transanally so that a 2–3-cm muscular cuff remained. The ganglionic colon was pulled through and sutured to the mucosal edge. There have been no operative complications. The postoperative follow-up period ranges from 9 months to 4 years. The preliminary functional results suggest that the patients gain early normal, age-appropriate bowel function postoperatively, without soiling or residual constipation.Correspondence to: R. Rintala