Alternative operative procedure for total colonic aganglionosis

Long-term results of total colonic agangliosis patients treated by preservation of the aganglionic right hemicolon and the ileo-cecal valve

“…Sophisticated research investigations in animal studies and human subjects have shown that the right colon has superior efficiency compared to the transverse and left colon in terms of water and electrolyte absorptive capacities, also leading to a reduced transit time [21][22][23][24][25][26][27][28][29][30]. Thus, the right colonic patch has achieved popularity in TCA surgical management [4][5][6]31]. Kimura has implemented a complex procedure, originally designed to treat intractable ileostomy diarrhea, where he patched the right colon to the ileum, leaving the patch vascularized by the mesenteric pedicle in the first stage [6].…”

“…To minimize the loss of fluids and electrolytes, various surgical techniques ranging from Martin's modification of Duhamel's retrorectal pull-through to Kimura's and Boley's colonic patch graft procedures have been proposed to partially retain the absorptive and reservoir functions of a part of the aganglionic colon [2,[4][5][6][7][8]. Furthermore, preservation of the aganglionic ileo-cecal valve (ICV) has been reported to be beneficial in the treatment of patients with TCA, as it acts as a natural barrier against bacterial backwash which could result in malabsorption of bile acids, vitamin B12 and fatty acids [9,10].…”

Comprehensive review of procedures for total colonic aganglionosis

“…Lengthy anastomoses with the aganglionated colon have been shown to result in increased long-term morbidity of nighttime incontinence and increased rates of enterocolitis [26,35,41,42]. Kimura, Boley, and others [11,12,18,20,25,43] have described the use of the ascending colon patch graft (given the greater absorptive capacity of the ascending colon compared to the descending colon or rectum) and have shown favorable results. Others still advocate the straight endorectal pullthrough techniques, quoting comparable functional results and more favorable morbidity profiles when compared to reservoir procedures [44].…”

Long-Term Results of the Treatment of Total Colonic Aganglionosis with Two Different Techniques

“…Duhamel-based pull-through with side-to-side ileocolonic anastomosis proposed by Martin [20] was for years the predominant treatment [5,10,13,18,21,29,30]. Preservation of the absortive function of the aganglionic colon was attempted with several types of colonic patches [1,2,4,9,10,13,16,22,23,29,30] although straight ileo-anal pull-through with either Duhamel, Soave or Swenson techniques can serve the same purpose [7,8,11,32]. The first of the surgical techniques used at our institution to treat this condition deserves particular comment.…”