Results of surgical treatment in Hirsch-sprung's disease.

Since 1948, a total of 89 patients with an aganglionic megacolon have been treated at the Children's Hospital of the Helsinki University Clinic. There were 68 cases of Hirschsprung's disease, and in 21 cases the anomaly had developed with anal atresia. In nine cases Hirschsprung's disease caused death in early infancy. Operations were performed in 59 cases. Three different types of operation were used. Abdomino-anal resection (Swenson, 1950), abdominal resection (Rehbein, 1958), and abdominoperineal resection (Duhamel, 1960). Most of the patients were under 2 years of age at the time of the operation. In infants under 12 months of age the Swenson procedure was carried out five times and the Duhamel operation 10 times; three of these operations were performed on cases under the age of 6 months (Table 1). A decompressive colostomy was done in 15 cases, but was used more rarely after the Duhamel operation became the routine (Tables 2 and 3). There has been no operative mortality. Three patients operated on by the Swenson method died later because of postoperative complications. In one case there was intestinal obstruction due to adhesions six months after the resection, in the second case the postoperative septicaemia caused encephalitis, and the patient died three months after the primary operation. In the third case a recto-urethral fistula was found three months after operation. A second pull-through operation four years after the primary operation was followed by a lethal peritonitis due to ischaemic necrosis of the distal colon. The case in the series of Duhamel operations was an infant 2 weeks old, operated on for diffuse peritonitis. An aganglionic segment consisted of the distal colon up to the transverse colon, and there were two perforations in the middle of the descending colon. The Duhamel procedure was followed, but the patient died 11 days later, mainly because of