EVALUATION OF A NEW TECHNIQUE OF ANAS TOMOSIS IN THE MODIFIED DUHAMELMARTIN OPERATION FOR HIRSCHSPRUNG\'S DISEASE

Hirschsprung's disease, also known as congenital aganglionic megacolon, is a congenital disorder which develops due to an absence of neural ganglia in a segment of large bowel. Most commonly, the rectum or rectosigmoid, and rarely other areas or the entire colon are involved. In this disease, all three neural plexi, i.e., the myenteric (Auerbach's) plexus, the superficial submucosal (Meissner's) plexus and the deep submucosal (Henle's) plexus are affected, therefore peristaltic waves do not occur in involved portions of the bowel. This causes a relative stenosis in involved areas and dilatation of the prestenotic bowel with resulting chronic constipation, recurrent diarrhea, and multiple episodes of enterocolitis. This series of events eventually leads to severe weakness, failure to thrive, abdominal distention and death. The only correct and effective form of therapy for this disorder is surgery. Surgical treatment can be performed by various methods, such as that proposed by Swenson et al,lI Soave,9 Duhame1,2 and Rehbein and Martin.4 Studies have shown that Martin's method has several advantages compared to other forms of surgical therapy. These are: 1/ Sensation is spared throughout the entire rectum. 2/ No dissection is performed anteriorly. 3/ Intraoperative bleeding is less. 4/ No catheter is required postoperatively. The modified Duhamel-Martin procedure which is the subject of this study has some practical benefits and less complications compared to the traditional Martin operation and is therefore our recommended technique for the treatment of Hirschsprung's disease.