Clinical effects of ascending colon patching ileorectal heart-shaped anastomosis on total colonic aganglionosis

OBJECTIVE: We studied the clinical effects of ascending colon patching ileorectal heart-shaped anastomosis in treating total colonic aganglionosis.

PATIENTS AND METHODS: From June 2006 to June 2013, 15 children with severe abdominal distension, low small intestine obstruction and intestinal perforation in the neonatal period, were enrolled in this study. In phase I, patients received emergency terminal ileum stoma plus multi-site colonic biopsy and 6 to 12 months later, ascending colon patching ileorectal heart-shaped anastomosis was conducted in phase II. The occurrence of postoperative complications was recorded. Patients' defecation and anal manometry during the follow-up period were monitored and recorded. All operations were successful, and the average hospitalization time was 10.5 days, and the average amount of bleeding was 30 mL.

RESULTS: There were 2 cases of enterocolitis, but no intestinal anastomotic leakage, no incision infection, no anal stenosis and no mortality. Postoperative follow-up lasted for 1 to 2 years with an average of 1.2 years. Perianal redness and erosion occurred in an early stage after the operation, but disappeared after 6 months. Postoperative defecation frequency was about 6 to 9 times, but after 2 years this frequency reduced to 2 to 3 times. Feces transformed from watery into soft forms. Normal results were obtained in the detection of serum K+, Na+, Cl-, HCO3–, hemoglobin, albumin and globulin levels in postoperative follow-up. Rectal rest pressure and anal canal rest pressure after a radical operation on megacolon were significantly lower than those of before operation (p < 0.05).

CONCLUSIONS: Ascending colon patching ileorectal heart-shaped anastomosis preserved right hemicolon with relatively good absorptive capability and complied with the physiology of colon. Meanwhile, the ileorectal heart-shaped anastomosis was conducted. The anastomotic stoma was in an oblique heart shape, and its aperture was wide and in different planes without stenosis, blind bag and gate syndrome. We concluded that ascending colon patching ileorectal heart-shaped anastomosis was an effective and feasible method for the radical operation on total colonic aganglionosis.

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