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DOI: 10.1055/s-2008-1042617
© Georg Thieme Verlag KG Stuttgart · New York
Eine neue maschinelle Anastomosentechnik bei tiefer anteriorer Resektion wegen Hirschsprungscher Erkrankung im Säuglingsalter
A New Mechanical Anastomosis Technique in Deep Anterior Resection for Hirschsprung's Disease in BabiesPublication History
Publication Date:
25 March 2008 (online)
Abstract
Since 1987 we perform a new technique of colorectal anastomosis in 6 babies resected because of severe Hirschsprung's disease. The operation was done electively in the seventh to eighth month of age. In the method of the so-called compression anastomosis the instrument is inserted through the anorectal canal at the head fitted with two plastic rings (see illustrations). In the rectal stump the instrument is opened up, the rectal bowel edge is slipped over the distal ring. The prepared proximal bowel edge is slipped over the second white coloured ring. The rings are approached to one another and the instrument is released. The knife on the inside cuts the bowel. The two rings are then joined by means of springs. The compression anastomosis is completed.
The two bowel edges are joined by compression via the two intraluminal plastic rings. These rings will pass spontaneously with the faeces days after operation. The diameter of the rings is 18 mm. Different diameters are available.
Our good experiences in more than 160 compression anastomoses in colorectal surgery of adults encouraged us to use the method also in children. We saw one complication of a rectovaginal fistula 4 weeks after the operation followed by a severe stenosis of the anstomosis.
The passing of the plastic rings was without any problem in all the cases. In the follow-up a bouginage was required only in the case mentioned above.
Zusammenfassung
Es wird über 6 Säuglinge berichtet, die bei einem gesicherten M. Hirschsprung und einem langen engen Segment jeweils im 6.-8. Lebensmonat elektiv tief anterior reseziert wurden. In allen Fällen wurde die Anastomosierung im Sinne einer maschinellen Kompressionsanastomose (AKA 2) durchgeführt. Nach dem meist spontanen Abgang des Kompressionsringes resultierte in jedem Falle eine weite, fremdkörper- und nahtfreie tiefe Kolonanastomose. Als Komplikation sahen wir eine rektovestibuläre Fistel, 4 Wochen nach der Operation, die aktuell unter dem Schutz eines Anus praeter abgeheilt ist.
Key words
Hirschsprung's disease - Compression anastomosis
Schlüsselwörter
Morbus Hirschsprung - Operationsverfahren - Kompressionsanastomose