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2008, Number 6

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Acta Pediatr Mex 2008; 29 (6)

Total agangliosis of the colon. New surgical tech-nique in the use of a colonic patch

Jiménez-Urueta PS, Gallego-Grijalva J, Sánchez-Michaca VJ, García-Galavis JL, Castañeda-Ortiz RA

Language: Spanish
References: 56
Page: 336-341
PDF size: 506.40 Kb.


ABSTRACT

Introduction: Total colon agangliosis is present in 4 to 5% of the cases in Hirschsprung’s disease. The series reported are short; the show a high surgical mortality between 13 to 23.5%. Martin described a technique that saves a portion of the left aganglionic colon to perform a terminal ileum side-to-side anastomosis, to improve fluid absorption, with an ileon descent type Duhamel technique. New surgical techniques have appeared in sight of the ileo-colic patch causes emptying problems. Sherman had better results with the excision of the entire aganglionic colon and an end-to-end anastomosis of the terminal ileum to the anal canal; he had no deaths. Kimura used a right colon isoperistaltic patch with two times surgery. We suggest a new surgery technique using right colon without moving it and a side-to-side anastomosis with terminal ileon descent type Soave in one surgical time.
Case reports: Three patients with congenital aganglionic colon are presented. The surgical technique used was a ileo-colon side-to-side anastomosis with the ascending and transverse colon as a patch. In the same surgical time an ileo-anal anastomosis was performed using Soave type descent. Ileostomy was kept open until the definitive closure was done.
Discusion: In the last 50 years surgical treatment for total colon agangliosis have been modified, but controversy continues. We suggest a new technique with a right and transverse colon side-to-side anastomosis and ileoproctoanastomosis with antiperistaltic distal ileon.


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