Rehbein's Procedure for Hirschsprung's Disease. An Appraisal of 45 Years*

Fuchs, Oliver; Booss, D

doi:10.1055/s-2008-1072289

Cited by 20 publications

(6 citation statements)

References 4 publications

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“…The Rehbein-procedure (RB) for children with Hirschsprung Disease (HD) is one of the techniques mostly used in Europe for the past 25 years [1, 2]. In our clinic good long-term results were seen despite the fact that a relatively large aganglionotic segment was left in situ compared with other techniques as the Soave, Swenson, or Duhamel procedures [3].…”

Section: Introductionmentioning

confidence: 85%

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

et al. 2010

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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.

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Section: Introductionmentioning

confidence: 85%

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

et al. 2010

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“…Soiling at least once a week occurred in 11 (27 %) of our 41 patients, 6 of whom had undergone a sphincteromyectomy. Approximately 85 % of the patients reported by Fuchs et al [3] had excellent or good function at follow up. This could be compared with 66 % of our cases having good function at follow up.…”

Section: Discussionmentioning

confidence: 88%

“…One exception is the study by Thepcharoennirund reporting very good results in 55 of 73 patients operated with Rehbein's procedure [15]. Fuchs et al [3] also recently reviewed a large series of 146 patients operated with Rehbein's method that were followed for an average period of 4 years. They included a historical series and found that constipation was reported in 15.4 % of the patients and faecal incontinence in 5.4 %.…”

Section: Discussionmentioning

confidence: 99%

“…This could be compared with 66 % of our cases having good function at follow up. If symptoms indicating persistent achalasia were present, Fuchs et al [3] performed anal dilation, which eliminated the symptoms in 95 % of the cases. Sphincteromyectomy was performed in only 4.7% of the patients, whereas 20% of our patients needed sphincteromyectomy postoperatively.…”

Section: Discussionmentioning

confidence: 99%

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Postoperative Obstructive Symptoms are Common after Rehbein's Procedure for Hirschsprung's Disease

Wester

Zetterlind²,

Fredin³

et al. 2006

Eur J Pediatr Surg

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Rehbein's procedure for Hirschsprung's disease has been questioned because several centimetres of aganglionic bowel are left behind, considered to result in obstructive symptoms. However, the reported outcome is similar to that after operations with other techniques. The purpose of this study was to review our experience of Rehbein's procedure during an 8-year period, focusing particularly on obstructive symptoms. We retrospectively studied 44 patients operated with Rehbein's procedure for biopsy-verified Hirschsprung's disease from October 1993 to October 2001. Three patients with total colonic aganglionosis and two patients who underwent total colectomy as a result of severe enterocolitis finally had a distal ileo-rectal anastomosis. Four (9 %) patients had a sphincteromyectomy before the Rehbein procedure. The patients' bowel function was evaluated by a questionnaire and an interview carried out 27 to 123 (mean 82) months after the operation. Two patients could not be traced and one patient, with total colonic aganglionosis, had an ileostomy at follow-up. Nineteen (46 %) of the 41 patients were treated with oral laxatives or enemas (12 patients), required repeated Botox injections (4 patients), or had undergone sphincteromyectomy (9 patients) due to obstructive symptoms. Eleven (27 %) of the 41 evaluated patients had soiling at least once a week at follow-up. Eleven (29 %) of 38 patients with a colorectal anastomosis had good bowel function without additional therapy. In conclusion, Rehbein's procedure for the treatment of Hirschsprung's disease is often complicated by obstructive problems.

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“…Among the lower urinary tract dysfunctions encountered after HD operations, urinary retention and enuresis have been the most emphasized findings during the early postoperative period [14][15][16][17][18]. Enuresis has been defined with an incidence of 5.4%, 10.4%, 15.3%, and 14.3% after Rehbein, Swenson, Soave, and Duhamel operations, respectively [10].…”

Section: Discussionmentioning

confidence: 99%