Soave-Like Transanal Endorectal Pull-Through
This chapter describes the surgical procedure for Soave-like transanal endorectal pull-through. The text includes an introduction that outlines the indications, risks, alternatives, essential steps, needed equipment, and variations in technique for the procedure in question. This is followed by a template operative dictation, which provides the reader with an operative report, such as is found in a patient chart or electronic medical record. A description is provided of the following critical concepts for this procedure: (1) placement of the Lone Star self-retaining retractor proximal to the dentate line, (2) placement of circumferential interrupted silk sutures proximal to the dentate line, (3) performance of a submucosal, then full-thickness dissection of the bowel until the level of the normal, ganglionic bowel is reached, (4) pull-through of colon, (5) placement of a deep layer of suture circumferentially from muscle to colonic serosa, (6) resection of the distal, aganglionic segment of bowel with electrocautery, (7) incising of the muscular cuff posteriorly, and (8) placement of a second layer of sutures from mucosa to mucosa to complete the coloanal anastomosis.