Oblique anastomosis in Soave endoanal pullthrough for Hirschsprung’s disease: a way of reducing strictures?

Abstract

The Soave endorectal pullthrough is a commonly performed procedure for the definitive management of children with Hirschsprung's disease (HD). Anastomotic stricture is a recognised complication of this procedure. There are multiple causes for these strictures, circular anastomosis being one of them. There are techniques described which alter the shape of the anastomosis of the pulled through bowel to decrease the incidence of strictures. These are oblique and heart-shaped anastomoses. We describe a new technique of oblique anastomosis where the pulled through bowel is anastomosed posteriorly 0.5 cm from the dentate line, and anteriorly 1.5 cm above this point. This oblique anastomosis is designed to lower the stricture rate. If a stricture does occur, an anastomosis near the anocutaneous junction on the posterior aspect also faciltates Y-V anoplasty. We present our experience using this technique. Seventeen consecutive children underwent the procedure at our institution between 2003 and 2006. Only one child developed an anastomotic stricture requiring anal dilatation.

The preliminary study of modified Swenson procedure in Hirschsprung disease

“…Therefore, we created oblique anastomosis with our modification almost indistinguishable from the original Swenson's method. Paul et al also described an oblique anastomosis with Soave endoanal pull-through [12]. They started mucosectomy 1.5 cm anteriorly and 0.5 cm posteriorly above the dentate line.…”

Rectal mucosal dissection during transanal pull-through for Hirschsprung disease: the anorectal or the dentate line?

“…One major complication after TAPT, often associated with high anastomosis, is rectal stenosis/anastomotic stricture, which may give rise to constipation or enterocolitis [10] through injury to the surgical anal canal. We had no incidence of postoperative constipation, enterocolitis, and/ or rectal stenosis in our ARL group, a strong indication that our anastomosis was not too high (Fig.…”

Oblique vs. Circular Anastomosis in the Children Underwent Soave’s Pull-Through Surgery for the Treatment of Hirschsprung’s Disease: Which Is the Best?

“…Several type of procedures were developed for the treatment of Hirschsprung's disease such as Duhamel, Soave's and posterior neurectomy 2,7,10 . Recent study showed less complication using oblique anastomosis 14 .…”