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

Abstract

PurposeAfter 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.MethodsRetrospective 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.ResultsAll 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.ConclusionsThe 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.

Outcome of transanal endorectal vs. transabdominal pull-through in patients with Hirschsprung’s disease

“…All other dehiscences healed uneventfully after resuturing. Visser et al reported a nearly similar incidence of anastomotic leakage for the transabdominal pull-through procedure (16%) and a lower leakage rate for TERPT (4%) [16]. In our study, the dehiscence was detected by a standardized routine examination.…”

“…This reflects a considerable but not significantly better outcome in favor of the TERPT group (p=0.09). Comparable reports achieved similar results [2,6,16,17]. The incidence in the literature ranges from 6% to 27% for TERPT and 6-59% for transabdominal pull-through procedures regarding persistent postoperative constipation [2,[17][18][19][20].…”

“…The high variation in the incidence of post-pull-through enterocolitis seems to be due to the different criteria for defining enterocolitis and variable follow-up times. No significant differences in post-pull-through enterocolitis between endorectal and transabdominal procedures have been published in comparable studies [2,16].…”

Transanal endorectal pull-through for classic segment Hirschsprung's disease: With or without laparoscopic mobilization of the rectosigmoid?

“…The other technique is the complete transanal endorectal pull-through introduced by de La Torre and Langer [5,6]. Both techniques have proven to be preferable to the open techniques [7][8][9][10]. It has not been clarified whether the best results are accomplished by the laparoscopically assisted transanal pull-through or the complete transanal pull-through.…”

Re-operations for Hirschsprung’s Disease: Long-term Complications

“…A Rehbein procedure may not be the currently preferred technique for HD. In their study Visser et al even suggested that the Rehbein procedure is obsolete, preferring to perform a transanal endorectal pull-through with a short muscle cuff [ 16 ] . Follow-up of our patients with residual aganglionosis after an initial Rehbein procedure revealed that half of them (n = 2) were completely continent; however, one suff ered from mild obstructive symptoms.…”