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pull through procedure

A definitive operation for Hirschsprung's disease, involving the removal of the abnormal segment of bowel of aganglionic tissue, pulling through the normal bowel and connecting it to the anus. It can be performed using an open or minimally invasive approach. However, it may sometimes fail if some of the abnormal bowel is left behind. Hirschsprung's disease is a blockage of the large intestine due to improper muscle movement in the bowel. It is because the ganglion cells are missing from a part of the bowel. Therefore, the muscle within the affected bowel wall does not contract to push feces, that causes a blockage. (Types) • transanal endorectal pull-through (by De la Torre-Mondragon: In the original procedure, a long rectal muscular cuff is dissected and left for anocolic anastomosis. It can sometimes lead to postoperative obstructive symptoms and enterocolitis. While a modified short mucosal dissection may increase the risk of injury to pelvic and perirectal nerves and other structures when dissected on the outside of the rectum deep in the pelvis.It is a safe and effective procedure with a long cuff dissection and a short V-shaped resected cuff anastomosis. • Swenson pull-through: The abnormal aganglionic part of the bowel is resected down to the sigmoid colon and rectum, and the normal colon and the low rectum are subsequently joined. • Duhamel pull-through: A pouch is made with aganglionic tissue on the ventral side and ganglionic tissue on the dorsal side. • Soave pull-through: Removes the mucosa and submucosa of the rectum and places the pull-through bowel within a cuff of aganglionic muscle to avoid the risks of injury to pelvic structures. • myomectomy: Excises a strip of muscle along one wall which breaks the circumferential action of the muscle group. Because with Hirschsprung's disease, the internal sphincter does not relax in response to rectal distension. (Most frequent postoperative complications) • Swenson procedure: Enterocolitis. • Duhamel repair: Constipation. • Soave pull-through procedure: Diarrhea and incontinence. After the surgery, occasionally, a temporary stoma is required. Toilet training may pose problems. Frequent loose stools may cause nappy rash.