Results with abdominal resection in Hirschsprung's disease.

For six years we have been practising abdominal resection for Hirschsprung's disease. The method is also known as segmental resection, anterior resection or State operation. The operative technique has, apart from certain small alterations, always remained the same. In the application of this procedure certain aspects have been revealed which are important for the theoretical interpretation of the disease and also have practical significance, no matter which method is considered the best. We need not go into the fundamental work of Swenson and Bodian. Swenson himself presented his views in detail five years ago at the first meeting of the British Association of Paediatric Surgeons, and Ehrenpreis (1955) lectured on Hirschsprung's disease in the newborn infant at the same time. In 1951 and 1952 w&e operated on our first cases according to Swenson's method (Swenson and Bill, 1948) and it occurred to us at that time that a dissection of the rectum might possibly lead to a disturbance of sexual potency, to incontinence and to disturbances in evacuation of the bladder. For this reason we switched to the State operation in 1953. Meanwhile it has been proved that this anxiety was unfounded. Swenson (1957) reported that eight patients who had been treated surgically had become fathers and that six others, all over 20, had no disturbance of potency. Wyllie (1957) reported that, among the large number of patients from the Great Ormond Street Hospital, hardly any lasting disturbances of bladder function had been observed. Incontinence of faeces usually disappears after some time. Only Hiatt (1958b) reports lasting troubles in 160%. Injury to the pelvic vegetative nerves can however only be avoided if the dissection of the rectum is made close to the wall of the bowel. As Swenson himself says, this part of the operation is time-consuming and difficult. But