Total colon aganglionosis--a new operation.

The colon-conserving concepts described by Martin in total colonic aganglionosis all presuppose that the distal end of the bowel is secured at the anus by the method of Duhamel. Many surgeons prefer a modification of the endorectal operation popularized by Soave when treating shorter segment Hirschsprung's disease. By combining the principles of the two methods we have evolved a technique in which the colon is anastomosed to the ileum using the GIA stapler. However, the anastomosis is commenced about 10 cm proximal to the distal cut end of the ileum, having first pulled the distal 10 cm through the muscular cuff of the rectum in the manner described by Soave. A temporary ileostomy is made. This method has been used clinically in two cases with gratifying results. By the use of this new technique the increase in absorptive area is achieved. At the same time the advantages of the endorectal pull-through operations are not compromised by any rectorectal dissection.