Kasai's rectoplasty in the treatment of Hirschsprung's disease and other types of colorectal dysganglionosis in children

Kasai's colo(ileo)rectoplasty with posterior triangular colonic flap was performed in 94 children (28 girls and 66 boys). In cases of total colonic aganglionosis Kasai's procedure was modified by Martin's extended side-to-side anastomosis. Aganglionosis (Hirschsprung's disease, HD) was found in 54 cases, HD associated with neuronal intestinal dysplasia (NID) in 26, hypoganglionosis (HG) in 5, HG and NID in 5, and NID in 4. A one-stage procedure was performed in 39 children; in 55 a preliminary enterostomy was carried out. Colo(ileo)rectoplasty without a simultaneous enterostomy was done in 85 children. Wound complications were observed in 18 cases (19.1%): infection in 12 and disruption in 6. Anastomotic leaks occurred in 11 cases (11.7%); subsequent diversion was inevitable in 6. In 10 children (10.6%) the anastomotic stricture was relieved by dilatation. Subsequent sphincteromyectomy of the internal anal sphincter because of constipation was performed in 8 children. Postoperative enterocolitis was observed in 3 cases (3.1%), in 2 of them due to residual dysganglionic colon. There was no mortality in our series. Kasai's procedure compares favorably with other interventions; its advantage is the low incidence of postoperative enterocolitis, however, the intended relief of chronic constipation may fail to occur. To relieve chronic constipation a larger sphincteromyectomy and greater resection of the rectal wall are necessary.