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Pediatric Surgery International
Published in: Pediatric Surgery International 11/2010

Open Access 01-11-2010 | Original Article

Is the Rehbein procedure obsolete in the treatment of Hirschsprung’s disease?

Authors: Reina Visser, Teun J. van de Ven, Iris A. L. M. van Rooij, Rene M. H. Wijnen, Ivo de Blaauw

Published in: Pediatric Surgery International | Issue 11/2010

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Abstract

Purpose

After 25 years of practice and positive results of the Rehbein-procedure (RB) for children with Hirschsprung Disease (HD), we changed to the less invasive transanal endorectal pull through (TERPT). The aim of this study was to compare short- and mid-term complications of these two procedures in our patients with HD.

Methods

Retrospective data of 50 HD patients were analyzed. Of these patients, 25 underwent RB (2000–2006) and in 25 the TERPT was performed (2005–2009). Medical records were reviewed to score complications and outcomes. Differences were analyzed using Chi-Square and Mann–Whitney U tests.

Results

All RB patients (100%) were given a colostomy compared with four patients (16%) in the TERPT group (p < 0.001). The average age at surgery in the RB group was 191 days whereas this was 72 days in the TERPT group (p < 0.01). The mean length of time of surgery in the RB group (158 min) was not significantly different from that in the TERPT group (183 min). Ganglion cells were located in all specimens at the proximal end of the specimens. The median time to first feeding significantly decreased from 2 days (range 1–11) in the RB group to 1 day (range 1–3) in the TERPT group (p < 0.01). The median length of hospital stay decreased in the TERPT group (8 days) compared with the RB group (10 days) (p < 0.001). There was a significant reduction in postoperative obstructive symptoms during the first 6 months in the TERPT group (48%) compared with the RB group (84%) (p = 0.016). Postoperative enterocolitis decreased from 40% in the RB group to 24% in the TERPT group although this was not statistically significant.

Conclusions

The introduction of TERPT reduced the need for colostomies; it shortened days to first feeding after surgery and reduced hospital stay. It also improved short-term outcome with less obstructive symptoms. We recommend TERPT surgery as a first choice in children with HD. we consider the RB now to be obsolete.
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Metadata
Title
Is the Rehbein procedure obsolete in the treatment of Hirschsprung’s disease?
Authors
Reina Visser
Teun J. van de Ven
Iris A. L. M. van Rooij
Rene M. H. Wijnen
Ivo de Blaauw
Publication date
01-11-2010
Publisher
Springer-Verlag
Published in
Pediatric Surgery International / Issue 11/2010
Print ISSN: 0179-0358
Electronic ISSN: 1437-9813
DOI
https://doi.org/10.1007/s00383-010-2696-0

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