Purpose
Various techniques have been used in the surgical treatment of Chagasic megacolon, including sympathectomy, sphincterotomy, anterior abdominal resection with high or low anastomosis, pull-through procedures, and Duhamel technique. However, results have not been consistently satisfactory, with reportedly high morbidity and mortality rates. The purpose of this study was to assess the technique and results of anterior rectosigmoidectomy with immediate posterior colorectal end-to-side stapled anastomosis for the treatment of Chagasic megacolon.
Methods
A prospective, noncontrolled study between 1989 and 2000 analyzed 49 patients with Chagasic megacolon. Preoperative barium enema confirmed Chagasic megacolon in all patients and preoperative anorectal manometry in 33 patients (67 percent). Rectal stump closure was undertaken by surgical stapling in 41 patients (84 percent); mechanical colorectal anastomosis was accomplished with a circular stapler in all patients.
Results
Symptoms of intestinal constipation ranged from 6 months to 40 years, Chagas' serology was positive in 98 percent of patients, 41 percent used bowel enemas for evacuation, and 71 percent had a history of fecaloma. The overall postoperative complication rate was 20 percent. Surgical complications occurred in 18 percent, 2 percent had nonsurgical complications, and there was no mortality. Postoperative barium enema was performed in 82 percent of cases, confirming the absence of disease. Postoperative anorectal manometry demonstrated normal resting pressure and rectal capacity; the inhibitory reflex remained absent and rectal sensitivity was increased. Ninety-three percent of patients were followed for more than 48 months, and all patients reported daily stool elimination without recurrence of constipation.
Conclusions
The current study indicates that our technique is effective for surgical treatment of patients with Chagasic megacolon.
Similar content being viewed by others
References
C Chagas (1909) ArticleTitleA new specie morbid to human: the Trypanosoma. (Trypanosoma cruzi) Brasil Med 28 161
C Chagas (1909) ArticleTitleNew Trypanosoma human infection. Morphologic and evolutive cycle of Schyzotrypanum cruzi Mem Inst Oswaldo Cruz 1 159
M Amorim A Corrêa Netto (1932) ArticleTitleHistopathology and pathogeny of megaesophagous and megarectum Ann Fac Med S Paulo 8 101–127
E Vasconcelos (1964) ArticleTitlePartial colectomy and cecorectal anastomosis for treatment of megacolon in adults Rev Hosp Clin Fac Med Sao Paulo 19 321–327 Occurrence Handle14251062 Occurrence Handle1:STN:280:CCqD2MrlsFw%3D
AA Raia (1970) ArticleTitleCurrent status of megacolon surgery Pren Méd Argent 57 1395–1400 Occurrence Handle1:STN:280:CS6D38fkvVM%3D
O Simonsen A Habr-gama P Gazal (1960) ArticleTitleEndoanal rectosigmoidectomy with resection of rectal mucosa Rev Paul Med 57 116–118
J Haddad AA Raia A Corrêa-Netto (1965) ArticleTitleRetrorectal colon pull-through and perineal colostomy for treatment of acquired megacolon AMB Rev Assoc Med Bras 11 83–88 Occurrence Handle5263077 Occurrence Handle1:STN:280:CS%2BC3czktlM%3D
J Haddad (1968) ArticleTitleTreatment of acquired megacolon with rectro-rectal lowering of the colon of perineal colostomy (modified Duhamel operation) Rev Hosp Clin Fac Med Sao Paulo 23 235–253 Occurrence Handle5679650 Occurrence Handle1:STN:280:CCaD3czks1Y%3D
WK Sieber WB Kiesewetter (1963) ArticleTitleDuhamel's operation for Hirschsprung's disease Arch Surg 87 111–119 Occurrence Handle13988933 Occurrence Handle1:STN:280:CC2C1c%2FnvVc%3D
FM Steichen JL Talbert MM Ravitch (1968) ArticleTitlePrimary side-to-side colorectal anastomosis in the Duhamel operation for Hirschsprung's disease Surgery 64 475–483 Occurrence Handle5691680 Occurrence Handle1:STN:280:CCeA1MfkvVA%3D
JL Talbert JH Seashore MM Ravitch (1974) ArticleTitleEvaluation of a modified Duhamel operation for correction of Hirschsprung's disease Ann Surg 179 671–675 Occurrence Handle4596051 Occurrence Handle1:STN:280:CSuC2cjktFc%3D
RA Parrish (1977) ArticleTitleModified Duhamel operation for Hirschsprung's disease Am Surg 43 283–286 Occurrence Handle860858 Occurrence Handle1:STN:280:CSiC2sbpvFA%3D
JM Jorge SD Wexner (1993) ArticleTitleAnorectal manometry: techniques and clinical applications South Med J 86 924–931 Occurrence Handle8351556 Occurrence Handle10.1097/00007611-199308000-00016
A Habr-Gama L Costa-Curta A Raia (1982) ArticleTitleSurgical treatment for megacolon-Duhamel-Haddad technique Rev Bras Cir 9 25–31
H Moreira (1971) ArticleTitleSurgical treatment of Chagasic megacolon by Duhamel-Haddad technique: personal experience Arq Gastroenterol 8 185–190
RR Medeiros JA Reis-Neto LS Leonardi AM Pires ME Accorroni (1980) ArticleTitleComparative study between Duhamel and Duhamel-Haddad technique for Chagasic megacolon surgery Rev Paul Med 96 61–65 Occurrence Handle6785865
AG Sousa FE Esper (1985) ArticleTitleSurgical treatment for acquired megacolon. Experience with 480 cases Rev Col Bras Cir 12 831–837
A Habr-Gama SF Bochini DR Kiss AM Souza SuffixJr (1990) ArticleTitleAbdominal rectosigmoidectomy with immediate anterior end-to-side stapled anastomosis for megacolon treatment Rev Bras Proctol 10 38
A Habr-Gama DR Kiss SF Bocchini MG Teixeira HW Pinotti (1994) ArticleTitleChagasic megacolon - abdominal rectosigmoidectomy with immediate end-to-side stapled anastomosis: preliminary results Rev Hosp Clin Fac Med Sao Paulo 49 199–203 Occurrence Handle7716372 Occurrence Handle1:STN:280:ByqB3s3jsVw%3D
D Cutait (1984) ArticleTitleCurrent status of pull-through procedures Rev Bras Coloproctol 4 73–79
Brenner S. Abdominoperineal proctocolectomy with delayed anastomosis for treatment of megacolon in adults [thesis]. Curitiba: Health Science Department, Federal University of Paraná; 1974.
JA Reis-Neto (1972) ArticleTitleLate results of Duhamel surgery for treatment of acquired megacolon Rev Med Bras 18 57
Lins-Neto MA. Modified Duhamel surgery with immediate colorectal anastomosis for treatment of chagasic mega-colon: technique and results [dissertation]. São Paulo: Faculdade de Medicina, Universidade de São Paulo; 1997.
JG Nettinho GS Cunrath LS Ronchi (2002) ArticleTitleRectosigmoidectomy with ileal loop interposition: a new surgical method for the treatment of Chagasic megacolon Dis Colon Rectum 45 1387–1392 Occurrence Handle10.1007/s10350-004-6430-7
Capelhuchnik P. Left colectomy for treatment of acquired megacolon [thesis]. São Paulo: Faculdade de Ciências Médicas, Santa Casa de São Paulo; 1975.
Author information
Authors and Affiliations
Corresponding author
Additional information
Reprints are not available.
About this article
Cite this article
Nahas, S.C., Habr-Gama, A., Nahas, C.S.R. et al. Surgical Treatment of Chagasic Megacolon by Abdominal Rectosigmoidectomy With Immediate Posterior End-to-Side Stapling (Habr-Gama Technique). Dis Colon Rectum 49, 1371–1378 (2006). https://doi.org/10.1007/s10350-006-0639-6
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10350-006-0639-6