A new operation for the treatment of Hirschsprung's disease.

The excision of the aganglionic segment of the recto-sigmoid colon proposed by Swenson is the logical outcome of the new conception of the aetiology of Hirschsprung's disease and I do not think it necessary to discuss it here any further. The operation which I shall describe constitutes but a technical variance of Swenson's operation and is not a new method; it has also some other applications apart from the treatment of congenital megacolon. The object of this operation is to exclude and not to resect the malformed rectum and all dissection of the pelvis is avoided. The functionally healthy proximal colon is brought down to the margin of the anus in a plane of anatomical cleavage, and thus the nervous system of the bladder and neuro-muscular apparatus of the sphincters are preserved in toto. A wide anastomosis between the colon and the excluded rectum is performed and, by preserving the rectum, an important area of reflex activity is preserved. Hirschsprung's disease is a serious condition but it is not a malignant disease in the usual sense of the term; therefore an operation designed to remedy the condition should not be of excessive severity, and there should be no risk that one functional anomaly (urinary incontinence or impotence) will be substituted for another. Swenson's operation is a delicate and difficult intervention which only gives excellent results if it is carried out by a very competent surgeon operating on children of a certain age. Since the characteristic deficiency of ganglia in Hirschsprung's disease nearly always affects the whole of the rectum down to the level of the internal sphincter, an extensive resection of the rectum, which is associated with considerable shock, especially in the newly born, must be performed in order to obtain a satisfactory surgical result. Dissection of the rectum can be carried out close to the muscular layer since one is not dealing with a malignant condition; it is nevertheless possible to traumatize the pelvic nervous plexus supplying