Elhalaby Ismael, Lim Irene Isabel P, Bokova Elizaveta, Egbuchulem Ifeanyi K, Rentea Rebecca M
Comprehensive Colorectal Center, Department of Surgery, Children's Mercy Kansas City, Kansas City, USA.
Department of Surgery, Faculty of Medicine, Tanta University, Tanta, EGY.
Cureus. 2024 Dec 11;16(12):e75539. doi: 10.7759/cureus.75539. eCollection 2024 Dec.
Long-segment Hirschsprung disease (HSCR) presents significant challenges in surgical management, often requiring extensive bowel mobilization and creative techniques to achieve tension-free anastomosis. Colonic derotation offers a viable solution for preserving bowel length and maintaining the ileocecal valve, which is crucial for postoperative bowel function. The procedure involves extensive colonic mobilization and strategic vascular divisions of the right and middle colic vessels while preserving the ileocolic and marginal arteries, followed by a 180° counterclockwise rotation of the colon around the ileocolic vascular axis. Critical aspects include ensuring proper bowel orientation post-derotation, the careful assessment of potential compression points, and the preservation of the appendix for potential future antegrade enema conduit creation. The procedure concludes with a transanal pull-through and coloanal anastomosis, achieving optimal bowel positioning without undue tension or laxity. This technique provides a valuable option in the surgical armamentarium for managing complex cases of long-segment Hirschsprung disease.
长段型先天性巨结肠（HSCR）在手术治疗中面临重大挑战，通常需要广泛游离肠管并采用创新技术来实现无张力吻合。结肠旋转复位术为保留肠管长度和维持回盲瓣提供了一种可行的解决方案，这对术后肠道功能至关重要。该手术包括广泛游离结肠以及在保留回结肠动脉和边缘动脉的同时对右结肠和中结肠血管进行策略性离断，随后将结肠围绕回结肠血管轴逆时针旋转180°。关键要点包括确保旋转复位后肠管方向正确、仔细评估潜在的压迫点以及保留阑尾以备将来可能创建顺行灌肠通道。手术最后进行经肛门拖出术和结肠肛管吻合术，实现最佳的肠管定位，且无过度张力或松弛。这项技术为处理复杂的长段型先天性巨结肠病例提供了手术方法中的一个有价值的选择。
