Manometric assessment of anorectal pressures in Hirschsprung's disease after Rehbein's operation with and without anorectal myectomy.

Anorectal manometric studies were performed on 15 patients with Hirschsprung's disease before surgery, on eight patients after Rehbein's procedure and seven patients after Rehbein's procedure with anorectal myectomy. The results were compared with those of 45 normal subjects. High anal resting pressure as well as an absence of the anorectal reflex proved to be responsible for obstructive symptoms in Hirschsprung's disease. Out of eight patients treated according to Rehbein's procedure, new internal sphincter relaxation was found in two, and anal resting pressures were significantly higher than those of the normal controls or of the patients treated according to Rehbein's procedure plus anorectal myectomy. It was demonstrated that anorectal myectomy is a more definitive procedure to restore the anal resting pressure to normal. Good postoperative continence can be achieved not only by the new internal sphincter relaxation but also by good propulsive movement which can overcome the remaining functional obstruction.