A pull-through procedure is the definitive operation for

Hirschsprung disease Hirschsprung's disease (HD or HSCR) is a birth defect in which nerves are missing from parts of the intestine. The most prominent symptom is constipation. Other symptoms may include vomiting, abdominal pain, diarrhea and slow growth. Symptoms usu ...

, involving the removal of the abnormal segment of

bowel The gastrointestinal tract (GI tract, digestive tract, alimentary canal) is the tract or passageway of the digestive system that leads from the mouth to the anus. The GI tract contains all the major organs of the digestive system, in humans and ...

that has no nerves, pulling through the normal bowel and

connecting ''Connecting...'' is an American television sitcom co-created and co-executive produced by Martin Gero and Brendan Gall for Universal Television. The series premiered on October 8, 2020 on NBC. In November 2020, the series was canceled after f ...

it to the

anus The anus (Latin, 'ring' or 'circle') is an opening at the opposite end of an animal's digestive tract from the mouth. Its function is to control the expulsion of feces, the residual semi-solid waste that remains after food digestion, which, d ...

. Several types of pull-through procedures exist including the Soave, Swenson and Duhamel. It can be performed using an open or minimally invasive approach.

Aim

A pull-through procedure is the definitive treatment for Hirschsprung's disease, with the aim of removing the abnormal part of the bowel and joining the normal part of the intestine with the anus.

Swenson pull-through

The original pull-through procedure was designed by

Orvar Swenson Orvar Swenson (7 February 1909 – 13 April 2012) was a Swedish-born American pediatric surgeon. He discovered the cause of Hirschsprung's disease and in 1948, with Alexander Bill, performed the first pull-through operation in a child with megacolo ...

and his colleague Alexander Bill. The abnormal aganglionic part of the bowel is resected down to the

sigmoid colon The sigmoid colon (or pelvic colon) is the part of the large intestine that is closest to the rectum and anus. It forms a loop that averages about in length. The loop is typically shaped like a Greek letter sigma (ς) or Latin letter S (thus ''s ...

and

rectum The rectum is the final straight portion of the large intestine in humans and some other mammals, and the Gastrointestinal tract, gut in others. The adult human rectum is about long, and begins at the rectosigmoid junction (the end of the s ...

, and the normal colon and the low rectum are subsequently joined.

Duhamel pull-through

The Duhamel pull-through is a modified Swenson's pull-through, first described in 1956.

Soave pull-through

The Soave procedure involves resecting the mucosa and submucosa of the rectum and pulling through the normal ganglionic bowel through the aganglionic muscular cuff of the rectum. It was introduced in the 1960s and initially did not include a formal join. It depended on scar tissue formation between the pull-through segment and the surrounding aganglionic bowel. The procedure was later modified by Boley.

Anorectal myomectomy

If the segment of Hirschsprung's is short, anorectal myomectomy maybe an alternative surgical option.

Laparoscopic approach

Georgeson Georgeson is a surname of English origin. It is a patronymic form of the name George. Notable people with the surname include: * Charles Christian Georgeson (1851–1931), agronomist, born on Langeland, Denmark * Chelsea Georgeson (born 1983), Au ...

first described laparoscopic surgical treatment of Hirschsprung's in 1999. Transanal pull-through procedures do not require an intra-abdominal dissection.

Complications

Complications include anaesthetic risks, infection,

bleeding Bleeding, hemorrhage, haemorrhage or blood loss, is blood escaping from the circulatory system from damaged blood vessels. Bleeding can occur internally, or externally either through a natural opening such as the mouth, nose, ear, urethra, vag ...

and perforation of the bowel. Frequent loose stools may cause nappy rash. Toilet training may also pose problems. Occasionally a temporary

stoma In botany, a stoma (from Greek ''στόμα'', "mouth", plural "stomata"), also called a stomate (plural "stomates"), is a pore found in the epidermis of leaves, stems, and other organs, that controls the rate of gas exchange. The pore is bor ...

is required. A pull-through may sometimes fail if some of the abnormal bowel is left behind.

References

{{Digestive system surgical procedures Digestive system surgery Surgical removal procedures