Is transanal resection of rectosigmoideum the future in the treatment of classical Hirschprung's disease?
Abstract
Introduction: The technique of transanal resection (TAR) of aganglionary part in rectosigmoid, published in 1998, has gradually become a standard operation technique in the treatment of Hirsckj^gprung's disease (H.d.). Since the TAR technique for H.d. is not yet generally widespread and has not been used in the Czech Republic yet, the authorscs intended to share their own experience and early results obtained by this surgical technique.
Cohort of patients: Seven patients (five boys and two girls) suffering from the classical recto-sigmoid form have been operated on since June 2003. One girl was affected with the Down's syndrome.
The age of the patients at the time of operation was between one and 24 months. Surgical technique: The extent of intestinal resection was determined on the basis of per-operation biopsy.
The length of the rectrosigmoid resection was between 25 and 35 cm. The colorectal anastomosis with partial sphincteromyectomy of internal anal sphincter was performed by the technique according to Swenson.
The antibiotic prophylaxis was secured by three doses of cefoxitin and one dose of isepamycin. Results: Intestinal passage reestablished 8-12 hours after the surgery, and complete oral intake began on day 3 or 4 after the operation.
All patients healed up without complications, the period of hospitalization was seven days on the average. The final diagnosis of H.d. was confirmed by biopsy examination of the dissected portion in all cases.
Conclusion: TAR is univocally the method of first choice in the surgery of classical Hirsprung's disease when compared with laparotomy or laparoscopy.