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HIRSCHSPRUNG's DISEASE (Aganglionic Megacolon) Definition Presence of Large, Non-Functional Distal
HIRSCHSPRUNG's DISEASE (Aganglionic Megacolon) Definition Presence of Large, Non-Functional Distal
Definitive Surgery
Principles
1.Resection of aganglionic segment
2.Anastomosis of proximal to the distal segment
Modes of surgery
1 .Swenson Operation:
In the Swenson procedure, the overly dilated and aganglionic
colon and rectum are excised to within 2cm above the dentate
line.
-The transected end of the normally ganglionated bowel is
sutured end-to- end with the distal anorectal segment.
2. Duhamel:
Operation the rectum is oversewn, and the proximal bowel is
brought between the sacrum and the rectum and sutured end-to-
side to the rectum above the dentate line. The intervening spur
of rectum and bowel is divided, and a side-to-side anastomosis
is made with a stapler
There is risk of faecaloma forming in the aganglionated rectal cuff
- Lester-Martin modification takes care of this complication
3. Soave Operation:
The Soave operation consists of dissecting between the mucosa
and the muscularis layer, pulling the proximal bowel through out
of the residual rectal stump and suturing it to the rectum just 2
cm above the dentate line.
4.Lynn Operation:
Rectal myectomy is used for distal rectal (short-segment)
aganglionosis
Approaches
1.Open Laparatomy
2.Laparascopy
3.Transanal
Age at Surgery
Depends on the age at which the diagnosis is confirmed –tissue)
and the availability of care.