Fig. 1
Types of pull-through repair for Hirschsprung’s disease. All repairs pull-through normal bowel with ganglion cells down to the dentate line. In the Swenson repair, a full thickness anastomosis of normal bowel is made. In the Duhamel repair, normal bowel is brought down behind the rectum and an anastomosis is created to the back of aganglionic bowel. In the Soave-Boley repair, mucosa is removed from the aganglionic bowel leaving a muscular cuff, and normal bowel is pulled through this cuff to create an anastomosis (Source: Christopher Coppola)
(i)
Rectosigmoidectomy (Swenson): Resection of the rectum, eversion of the rectal stump outside anus, and end to end anastomosis between end of normal colon, and rectal stump.
(ii)
Retrorectal pull-through (Duhamel): Anastomosis of the normal colon to the posterior surface of the aganglionic rectal stump. This is often done with a stapler inserted in the anus to perform a side to side anastomosis between normal colon and rectum.
(iii)
Endorectal pull-through (Soave-Boley): Submucosal dissection is performed via anus to lift the mucosa off of the aganglionic rectum. This leaves behind a cuff of muscle above the anus. The cuff of muscle is splint to the front and back to eliminate constriction. The normal colon is brought through this split cuff and anastomosed to the edge of mucosa above anus.
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