Limited surgery for lower-segment Hirschsprung's disease.

OBJECTIVE: To determine if rectal myectomy is an effective treatment for a specific group of patients with Hirschsprung's disease. DESIGN: Retrospective series with follow-up of 6 to 132 months (mean follow-up, 37.1 months). SETTING: Children's hospital. PATIENTS: Fourteen children aged 2 to 14 years with chronic constipation and nondiagnostic barium enema contrast study findings. INTERVENTION: Posterior rectal myectomy. MAIN OUTCOME MEASURES: Laxative use, frequency of stools, incidence of soiling or incontinence, and patient's assessment of improvement. RESULTS: The conditions of all 14 patients improved regardless of the presence of ganglion cells in the myectomy specimen; there were six excellent, six good, and two fair assessments. laxatives were used intermittently by seven of 14 patients. No patients complained of incontinence or soiling. CONCLUSIONS: Rectal myectomy is an effective, less-extensive operation that should be considered for older children with Hirschsprung's disease.