Abstract
Bi-directional ano-rectal manometric studies using a double lumen tube were performed in 13 patients with Hirchsprung's disease who had undergone Z-shaped anastomosis. After Z-shaped anastmosis, the anterior wall of the rectum is aganglionic, but the posterior wall is ganglionic. Therefore, there may be a significant difference anatomically and physiologically between the anterior and the posterior wall. Using a bi-directional double lumen tube, resting pressure, resting anal canal pressure and anal canal contractile wave were measured but there was no statistically significant difference. But 80% of the postoperative cases showed dissociation of resting pressure profile. Recto-anal reflex was found in 6 postoperative cases. Reflex was clear in the posterior wall, but unclear or none in the anterior wall. These facts suggested that the mechanism of the recto-anal reflex after Z-shaped anastomosis for Hirschsprung's disease was due to the peristalsis of the posterior normal colon. Further investigation will be necessary to elucidate the postoperative anorectal movement.
