[Differential surgical treatment of idiopathic megadolichocolon in adults].

An analysis of results of surgical treatment of 158 adult patients with the syndrome of chronic colostasis (SCC) has shown that the rectal form of Hirschsprung's disease (RFH) was diagnosed in 57 patients while idiopathic megadolichocolon (IMC)--in 101 patients. There were two types of SCC: proctogenic and cologenic. The proctogenic type appears in patients with RFH due to hypogangliosis and agangliosis, and in patients with IMC--as a result of dystrophy of ganglionic neurons of the Meissner plexus of the rectum. The computed morphometry and histochemical investigations have shown that hypogangliosis and agangliosis in RFH were of congenital origin while dystrophy of the rectal ganglia in many patients with IMC was an acquired pathology. The marginal variant of the second type of the colon structure can be considered as a cause of SCC. A new operation--endofascial resection of the rectum--is proposed for treatment of proctogenic SCC. The differential surgical strategy with pathomorphogenesis of SCC taken into account allowed to get satisfactory results in 73% of cases.