Proctectomy with Coloanal Anastomosis

For adult patients diagnosed with Hirschsprung's disease, the colon usually needs decompression as the initial treatment. At laparotomy, a loop ileostomy is performed and the colon is purged of stool. The segment above the agan-glionic portion is usually massively dilated and the stool is hard and must be broken up and irrigated. A tube is usually placed in the ileum at the area of the future ileostomy and irrigated with large amounts of warm saline while breaking up the stool downstream. An ileostomy is selectively chosen so as not to interfere with the next operation. It usually takes approximately 6 months for the sigmoid to regain tone and decrease to an acceptable size, and at this point, a proctectomy with coloanal anastomosis is performed. Ganglia in the distal colonic segment are verified by frozen section at the time of operation. After 3 months, the anastomosis is cleared for leaks with a Gas-trografin enema, and the ileostomy is closed.

In very rare circumstances, a proctectomy with coloanal anastomosis is advocated for patients with rectal or hindgut dysfunction. These patients should be screened very carefully to rule out colonic dysmotility or pelvic floor dysfunction.

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