what procedure/surgeon to choose

So here we are.  We just had an apt with our current surgen Dr. Jacir out of NJ Morristown General Hospital.  He want’s to prefrom the Sove procedure in a few weeks.  I am not too sure about this.  I have done my research and I am leaning torward having Dr. Marc Levitt in Cincinatti (who will do a swenson procedure).  


I was reading an article from the journal of the American academy of pediatrics
PEDIATRICS Vol. 109 No. 5 May 2002, pp. 914-918 
Hirschsprung’s Disease: A Review Orvar Swenson, MD
article here http://shuurl.com/W2682 

Here are a few items that stuck out for me…

  • It is difficult to comprehend how an aganglionic rectum can function normally. It is true that with a series of modifications, the troublesome pouch problem may have been eliminated. However, half of the rectum and some of the rectosigmoid wall are aganglionic tissue with limited peristaltic contraction. Additional evidence that when half the circumference of intestine is made up of aganglionic tissue there is functional disruption and stasis is suggested by the results of the Martin procedure used in patients with total colon agangliosis.  

  • Another concern expressed about operative procedures for Hirschsprung’s disease is data on sexual function.  Polley et al59stated that the advantage of the Soave modification over the Swenson operation was that the rectal intramural dissection ensuredthat no damage would be done to the pelvic neural structures that might result in urinary and fecal incontinence and possiblydamage sexual function. The report of Sherman et al26 demonstrated that these hypothetical fears are groundless and that all thedefective tissue can be removed during extrarectal dissection without these postulated damages.  

  • The Soave modification is complicated by recurrent enterocolitis and constipation. Holschneider et al61 found in his large reviewthat the Soave modification had the highest incidence of postoperative enterocolitis followed by the Duhamel. The least incidence occurred after the Swenson operation.60,61 Kimura et al62 found persistent rectal achalasia in postoperative patients treated with the Soave modification and subjected them to posterior rectal myectomy. They believe that the cause of this was the telescoping type of anastomosis associated with this Soave technique, which incorporates an extra layer into the anal canal.  

  • The concept that removing the aganglionic rectum obliterates a reflex that causes relaxation of the sphincter as Varma andStephens65 reported is seriously questioned. A series of reports has concluded that the sensation of rectal fullness is mediatedfrom sensory endings in the levator and puborectalis sling rather than the rectum.6668 Adults treated by the original operationwith removal of the aganglionic rectum insist that they can detect rectal fullness.  
  • The Duhamel and Soave modifications are less attractive than the original Swenson operation because of the greater numbers of complications and the poorer long-term outcomes. 

The above ar emy concerns.  Any feedback out there?

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