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Surgical maneuvers for long-segment Hirschsprung pull-through in unique patients

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Abstract

Purpose

Patients with Hirschsprung disease affecting the splenic flexure or more proximal segments present a surgical challenge. Mobilizing the transverse colon to the pelvis during a pull-through may obstruct the distal ileum, or the length may be insufficient to reach the lower pelvis. This retrospective study aimed to describe two surgical techniques that facilitate mobilization of the transverse colon and their outcome.

Methods

We included patients operated on between April 2017 and April 2024 and analyzed sex, comorbidities, type of pull- through, age at pull-through, history of previous surgeries, cause of the proximal transverse colon pull-through, technique used (Deloyers or Turnbull), complications , postoperative outcome and follow-up. The first technique used was the maneuver described by Turnbull. This operation creates a mesenteric defect and mobilizes the colon into this mesenteric window at the distal ileum level. The second technique was described by Deloyers and involves a 180-degree rotation of the right colon by dissecting the right colon attachment and the hepatocolic ligament. The cecum and the ileocecal valve are placed in the right upper quadrant, and the distal colon is mobilized into the pelvis.

Results

We included 13 patients, 12 boys and 1 girl. Eight patients had previous surgeries in another hospital: five had an initial transverse colostomy, and three had an ileostomy. The remaining five had the initial operation in our hospital: two had an ileostomy, two had a colostomy, and one had a primary pull-through. The median age at pull-through was 16 months (4–59 months). We used the Turnbull technique in four patients whose aganglionosis was limited to the middle transverse colon. The Deloyers technique was used in the remaining patients, with ganglion cells in the proximal transverse colon. We left a protective ileostomy in five patients. The median follow-up was 4.5 years (3 months to 10 years). The stoma takedown is pending in one patient.

Conclusion

The Turnbull and Deloyers techniques were helpful in patients with aganglionosis affecting the transverse colon.

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Data Availability

No datasets were generated or analysed during the current study.

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Authors and Affiliations

  1. Cirugía Pediátrica Colorrectal, Centro Colorrectal Para Niños, Hospital Ángeles Puebla, Puebla, México

    M. Zornoza & A. Ruiz

  2. Cirugía Pediátrica, Hospital del Carmen de Maipú, Santiago de Chile, Chile

    L. Muñoz

  3. International Center for Colorectal Urogenital Care, Department of Surgery, Division of Pediatric Surgery, Children’s Hospital Colorado, Denver, USA

    L. De la Torre

Authors
  1. M. Zornoza
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  2. L. Muñoz
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  3. A. Ruiz
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  4. L. De la Torre
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Contributions

Study conception and design: MZ and AR Data acquisition: MZ, LM and AR Analysis and data interpretation: MZ, LM and AR Drafting of the manuscript: MZ, LM and LDT Critical revision: MZ, LM, AR and LDT

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Correspondence to M. Zornoza.

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Zornoza, M., Muñoz, L., Ruiz, A. et al. Surgical maneuvers for long-segment Hirschsprung pull-through in unique patients. Pediatr Surg Int 40, 180 (2024). https://doi.org/10.1007/s00383-024-05767-0

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