Soave Procedure

Franco Soave,10 an Italian surgeon, created this ingenious and appealing operation, with the specific theoretical purpose of avoiding the consequences of nerve damage provoked by an imprecise Swenson dissection. The aganglionic rectosigmoid is resected by an endorectal dissection, theoretically minimizing the risk of pelvic injury (Fig. 24.3A,B).

The normoganglionic colon is passed through the rectal muscular cuff left after the endorectal dissection (Fig. 24.3C,D). There is no aganglionic segment of rectum left, such as that left with the Duhamel procedure. This operation is less reproducible than the Duhamel procedure and requires meticulous technique in the dissection of the mucosa from the muscular cuff. The endorectal dissection is performed immediately around the mucosal layer and inside the smooth muscle layer of the bowel (Fig. 24.3C). This dissection is usually initiated 1 or 2 cm above the peritoneal reflection. It is carried down to a point about 1 cm above the pectinate line in order to preserve the anal canal with its sphincteric mechanism and sensation. The normoganglionic colon is anastomosed to the anal canal about 1 cm above the pectinate line (Fig. 24.3D). Soave originally performed this operation without a colostomy, leaving a portion of the pulled-through colon protruding well beyond the anal skin margin. About a week later, this portion of the bowel was resected and an anastomosis was created between the normoaganglionic bowel

Modified Duhamel Operation Hirschsprung

Figure 24.2. Duhamel technique. a: Resection of the dilated portion and part of the aganglionic segment. b: Presacral, retrorectal dissection. c: Pull-through of normal ganglionic bowel. d: Incision of the posterior rectal wall, above the pectinate line. e: Pull through of normal aganglionic colon through the window in the posterior rectal wall. f: Creating a wide anastomosis between normal ganglionic and aganglionic segment. g: Finished operation. From Pen a A. Surgical treatment of Hirschsprung's disease. In: Wexner SD, Bartolo DCC, eds. Constipation: Etiology, Evaluation and Management. New York: Butterworth-Heinemann, 1995:168-175, reproduced by permission of Edward Arnold.

Figure 24.2. Duhamel technique. a: Resection of the dilated portion and part of the aganglionic segment. b: Presacral, retrorectal dissection. c: Pull-through of normal ganglionic bowel. d: Incision of the posterior rectal wall, above the pectinate line. e: Pull through of normal aganglionic colon through the window in the posterior rectal wall. f: Creating a wide anastomosis between normal ganglionic and aganglionic segment. g: Finished operation. From Pen a A. Surgical treatment of Hirschsprung's disease. In: Wexner SD, Bartolo DCC, eds. Constipation: Etiology, Evaluation and Management. New York: Butterworth-Heinemann, 1995:168-175, reproduced by permission of Edward Arnold.

Soave Surgery Hirschsprung Diseases

Figure 24.3. Soave technique. A: Resection of dilated colon plus intraperitoneal aganglionic segment. B: Endorectal intrapelvic dissection. C: Resection of the mucosal aganglionic segment down to the pectinate line. D: Pull-through of normal ganglionic bowel through the muscle cuff and anastomosis 1 cm above the pectinate line. From Pen a A. Surgical treatment of Hirschsprung's disease. In: Wexner SD, Bartolo DCC, eds. Constipation: Etiology, Evaluation and Management. New York: ButterworthHeinemann, 1995:168-175, reproduced by permission of Edward Arnold.

and the anal canal. This operation was modified by Boley,11 who proposed a primary anastomosis, avoiding the second procedure.

Constipation Prescription

Constipation Prescription

Did you ever think feeling angry and irritable could be a symptom of constipation? A horrible fullness and pressing sharp pains against the bladders can’t help but affect your mood. Sometimes you just want everyone to leave you alone and sleep to escape the pain. It is virtually impossible to be constipated and keep a sunny disposition. Follow the steps in this guide to alleviate constipation and lead a happier healthy life.

Get My Free Ebook


Post a comment