Swenson’s procedure for the patients with Hirschsprung’s disease was introduced after strictly controlled laboratory works by Orvar Swenson in 1948. The procedure needed meticulous rectal dissection to reduce complications to the surrounding structures. The largest series including 880 patients studying both the immediate operative and the long-term outcomes of the patients treated with the Swenson’s procedure was reported in 1989. The result was affirmative and supportive, never inferior to Soave and Duhamel’ pull-through. This approach has changed considerably over the past four decades, changing to primary repair, using laparoscopy, and approaching transanally.
The author describes technical advances relating complete removal of the aganglionic segment, an oblique anastomosis above the dentate line, an extra-pelvic anastomosis, and a transanal technique. The dentate line is a key landmark for Swenson’s pull-through procedure in order to preserve fecal continence and facilitate voluntary bowel movement. Swenson described the oblique line of resection and anastomosis that is 0.5–1.0 cm apart from the dentate line on the posterior midline and 2.0 cm above the dentate line anteriorly. The author emphasizes importance of adjustment to the resection level of the internal sphincter on the posterior midline according to the various levels of pull-through bowel. As for the transanal pull-through, Soave’s technique is approaching to Swenson’s concept by reducing the residual length of the muscle cuff to 1.0 cm above the dentate line, now referred as “Soaveson’s” procedure. Pediatric surgeons must keep learning details of the new techniques for Hirschsprung’s disease on the proper training system.
KeywordsHirschsprung’s disease Swenson’s procedure Modified Swenson’s procedure Kimura’s colon patch Extensive aganglionosis Transanal approach Dentate line
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