Abstract
Surgical treatment of Hirschsprung's disease has well been established and good results were reported in various operations. But there have been few reports on secondary operations following the primary bowel resection. From 1963 to 1983 we have experienced 129 cases of Hirschsprung's disease, of which 14 cases required second operation. The failed first operations included the following procedures; Duhamel in 3 cases, modified Duhamel in 5 cases, Z-shaped anastomosis in 3 cases, and anorectal myectomy in 3 cases. 6 cases treated by Duhamel's or its modification by Grob developed rectal blind pouch with a fecalona. Clushing of the septum or Z-shaped anastomosis were effective for these cases. Preoperative digital dilatation of the anal canal is essential before using oval shaped clushing clarnp. Carefull preparation of the bowel should be performed preoperatively because complications such as intestinal fistula, abscess formation, anal stenosis, result in bad anorectal function in spite of the secondary repair. In retrorectal transanal pull-through procedures, posterior half transverse incision should be placed at dentate line for the release of the sphincter achalasia. The rate of re-operation following anorectal myectomy was high (42.9%) in our own cases.
