Abdominorectal Pull-Through Resection for Cancer and for Hirschsprung’s Disease

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THE complications following conventional pull-through procedures for cancer of the mid-rectum or Hirschsprung’s disease are certainly not to be minimized. Ischemic necrosis of the pulled-through segment, and retraction and abscesses in the presacral space are the most difficult complications to treat. Waugh and Turner1 in summarizing their extensive experience and excellent results state that 13.4 per cent of their patients had some degree of slough and retraction of the pulled-through colon, while in 20.9 per cent infection developed in the presacral space.

We believe that ischemic necrosis, retraction, and presacral infection are due to: (1) the too frequent reliance on the sigmoid colon as the pulled-through segment, (2) insufficient external fixation of the exteriorized colonic segment, and (3) immediate replacement of a colorectal anastomosis into a compartmented pelvic hematoma (as in Swenson’s operation). The technic reported here ensures the removal of the sigmoid colon (which occasionally is of doubtful viability after mobilization), adequate and absolute fixation of the exteriorized colonic segment on the perineum, and a safe, delayed colorectal anastomosis after the incubation period of pelvic abscess is past, or the infection, if present, has been controlled.

The delayed anastomosis technic described here was evolved by us in 1952 for adults having small cancers located in the mid-rectum, and in whom a Swenson type2 of pull-through resection was performed. In 1953, we utilized the same technic in children undergoing resections for Hirschsprung’s disease. In September, I960, in Sao Paulo, Brazil, one of us (R.B.T.) was pleased to note that Dr. . . .



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