A simplified approach to endorectal pull-through: the feasibility of chemically destroying rectal mucosa.

In order to eliminate the mucosal dissection of the endorectal procedure, a puppy model was developed in which the rectal mucosa was treated with either 5% phenol or 1N sodium hydroxide prior to pulling the proximal colon through and performing an anal anastomosis. The phenol and sodium hydroxide were neutralized respectively with 70% isopropyl alcohol and 1% acetic acid to prevent injury to the pulled-through bowel. Six puppies were treated in each group. All dogs survived the study and were able to return to normal diets. The dogs were sacrificed at one, two and three-week intervals after operation. Microscopic examination of the rectum demonstrated that, in the group treated with sodium hydroxide, the mucosa was destroyed and was replaced with a granulating layer which was adherent to the pulled-through colonic serosa. The group treated with phenol did not show the same degree of mucosal destruction and, in these animals, the pulled-through bowel was not adherent to the rectum. This study suggests that, with refinement, chemical destruction of the rectal mucosa may be a further beneficial modification of the endorectal procedure.