Hirschsprung Disease: Transanal Pull-Through

Published on 27/02/2015 by admin

Filed under Pediatrics

Last modified 22/04/2025

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CHAPTER 18 Hirschsprung Disease

Transanal Pull-Through

Step 2: Preoperative Considerations

Step 3: Operative Steps

Leveling Biopsy

Pull-Through

Four 4-0 silk sutures are placed to evert the anus (Fig. 18-3). Some surgeons prefer the Lonestar retractor, but we find that it tends to tear through the tissue in infants and is therefore more traumatic.
With a nasal speculum in the anus, a circumferential mucosal incision is made using a needle-tip cautery (Fig. 18-4). The mucosal incision should be made 0.5 cm above the dentate line in an infant and up to 1.0 cm above the dentate line in an older child.
The dissection of the muscular cuff then proceeds using the needle-tip cautery (Fig. 18-5). The correct plane is in the submucosa, between the mucosa and the circular muscle fibers. It has a white appearance and is relatively avascular.
The dissection then proceeds proximally on the outside of the rectum, again taking care to stay immediately on the outside of the rectal muscle (Fig. 18-7). The rectal blood supply is divided as it enters the wall of the bowel. Most blood vessels can be “pinch-burned” (cauterized) and then transected. Larger vessels can be ligated and divided.

Step 4: Postoperative Care

Step 5: Pearls and Pitfalls