Habr-Gama A, Kiss D R, Bocchini S F, Teixeira M G, Pinotti H W
Serviço de Cirurgia do Cólon e Reto da Disciplina, FMUSP.
Rev Hosp Clin Fac Med Sao Paulo. 1994 Sep-Oct;49(5):199-203.
Abdominal rectosigmoidectomy with end to side colorectal mechanical anastomosis is proposed as a new technique for surgical treatment of Chagasic megacolon. The rectum is sectioned and closed at the level of the peritoneal reflexion. The end of the descending colon is anastomosed to the posterior surface of the rectum, as distal as possible, using the intraluminal stapler (Ethicon CDH33). The final result of the operation is similar to Duhamel-Haddad technique with the advantage of being a one stage operation. Forty-three patients with chagasic megacolon were operated on during the period 1989-1994. Twenty-seven were female and 16 were male with ages ranging from 23 to 76 and a mean of 46.1 years. Results obtained were satisfactory; there were no deaths; only three postoperative complications occurred (6.9%). Only one of these (dehiscence of the rectal cupula) was specific for the proposed technique. The two others were intestinal obstruction, due to volvulus of the small intestine in one case and to adhesions in the other. All complications were managed by surgery. All patients are being followed regularly and up to the present time they report daily bowel movements, passing well-formed stools. There are no complaints of fecal incontinence sexual function or disturbed formation of fecaloma in the rectal stump. The colorectal anastomosis was ample in all patients. Since this is a one stage operation with a low rate of complications, the short hospital stay largely compensates the cost of the mechanical suturing device. Regarding recurrences, a long follow-up period of at least 10 years is necessary to evaluate the real effectiveness of this technique.
腹直乙状结肠切除术加结直肠端侧机械吻合术被提议作为治疗恰加斯病巨结肠的一种新手术技术。在腹膜反折水平切断并封闭直肠。使用腔内吻合器（Ethicon CDH33）将降结肠末端尽可能远地吻合至直肠后表面。手术的最终结果与杜哈梅尔 - 哈达德技术相似，优点是为一期手术。1989年至1994年期间，对43例恰加斯病巨结肠患者进行了手术。27例为女性，16例为男性，年龄在23岁至76岁之间，平均年龄为46.1岁。获得的结果令人满意；无死亡病例；仅发生3例术后并发症（6.9%）。其中只有1例（直肠穹窿裂开）是所提议技术特有的。另外2例是肠梗阻，1例是由于小肠扭转，另1例是由于粘连。所有并发症均通过手术处理。所有患者均定期接受随访，目前他们报告每日排便，排出成形粪便。无大便失禁、性功能障碍或直肠残端粪瘤形成方面的主诉。所有患者的结直肠吻合口均宽敞。由于这是一种一期手术，并发症发生率低，较短的住院时间在很大程度上弥补了机械缝合装置的成本。关于复发情况，需要至少10年的长期随访期来评估该技术的实际有效性。
