Abstract
Surgical treatment of chagasic megacolon has suffered innumerable transformations over the years. Poor knowledge of the disease physiopathology is one of the reasons. From January 1977 to December 2003, 430 patients were submitted to surgical treatment for chagasic megacolon. Of these procedures, 351 were elective and 79 emergency operations carried out at the University Hospital of Ribeirão Preto. Four elective operations, most frequently used, should be singled out: anterior rectosigmoidectomy (52.71%), left hemicolectomy (18.23%), Duhamel-Haddad operation(15.95%), and total colectomy (5.98%). From the 79 exploratory laparotomies performed on an emergency basis, 53 (67.09%) required intestinal resection. From the 430 patients operated upon, 268 (62.33%) progressed without recurrence of intestinal constipation, and 71 (15.51%) had a recurrence. Based on the data collected, left hemicolectomy had the highest constipation recurrence rate compared to other operating procedures; anterior retosigmoidectomy had less complication episodes and a larger recurrence of intestinal constipation in comparison to the Duhamel-Haddad operation. Emergency operations, mainly for the treatment of volvulus and fecaloma, presented high morbidity and mortality and required extensive intestinal resections, stomas and reoperations.
Highlights
Surgical treatment of chagasic megacolon has suffered innumerable transformations over the years
In the 1930, in the period of the sphincter achalasia theory, Correa Neto was favorable to resection of the socalled functional colon sphincters.[4,5]
The initial operation procedures based on the achalasia concept sectioned the internal anus or pelvis-rectal sphincters
Summary
Surgical treatment of chagasic megacolon has suffered innumerable transformations over the years. Poor knowledge of the disease physiopathology is one of the reasons for the diverse operation procedures as well as the complication indexes related to them, and last but not least, the difficulties in long term post-surgery following. In the 1930, in the period of the sphincter achalasia theory, Correa Neto was favorable to resection of the socalled functional colon sphincters.[4,5] The initial operation procedures based on the achalasia concept sectioned the internal anus or pelvis-rectal sphincters. The achalasia concept was gradually substituted by the one of “distal intestine dyskenesia” considering rectal or distal functional obstruction, which differs from achalasia by the greater extension of the affected intestinal segment Assuming that colon dilatation was the main cause of the disease, surgeons in the past practiced sigmoidectomy, resecting only the dilated colon portion and keeping the rectum and colon portion, which macroscopically looked normal.[1,2,3]
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