Swenson-Like Transanal Pull-Through
This chapter describes the surgical procedure for Swenson-like transanal 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 anal retractor proximal to the dentate line, (2) placement of circumferential interrupted silk sutures proximal to the dentate line, (3) performing a full-thickness dissection of the bowel from just above the preserved anal canal to the level of the normal, ganglionic bowel, (4) pull-through of ganglionic segment of bowel to dissection 1 cm above the anal canal, (5) place deep layer of sutures circumferentially from muscle to colonic serosa, (6) resection of distal, aganglionic segment of bowel with electrocautery, and (7) placement of a second layer of sutures from mucosa to mucosa to complete the colo-colonic anastomosis.