Surgical treatment of Chagasic megacolon by abdominal rectosigmoidectomy with immediate posterior end-to-side stapling (Habr-Gama technique).
OBJECTIVE
Various techniques have been used in the surgical treatment of Chagasic megacolon, including sympathectomy, sphincterotomy, anterior abdominal resection with high or low anastomosis, pull-through procedures, and Duhamel technique. However, results have not been consistently satisfactory, with reportedly high morbidity and mortality rates. The purpose of this study was to assess the technique and results of anterior rectosigmoidectomy with immediate posterior colorectal end-to-side stapled anastomosis for the treatment of Chagasic megacolon.


METHODS
A prospective, noncontrolled study between 1989 and 2000 analyzed 49 patients with Chagasic megacolon. Preoperative barium enema confirmed Chagasic megacolon in all patients and preoperative anorectal manometry in 33 patients (67 percent). Rectal stump closure was undertaken by surgical stapling in 41 patients (84 percent); mechanical colorectal anastomosis was accomplished with a circular stapler in all patients.


RESULTS
Symptoms of intestinal constipation ranged from 6 months to 40 years, Chagas' serology was positive in 98 percent of patients, 41 percent used bowel enemas for evacuation, and 71 percent had a history of fecaloma. The overall postoperative complication rate was 20 percent. Surgical complications occurred in 18 percent, 2 percent had nonsurgical complications, and there was no mortality. Postoperative barium enema was performed in 82 percent of cases, confirming the absence of disease. Postoperative anorectal manometry demonstrated normal resting pressure and rectal capacity; the inhibitory reflex remained absent and rectal sensitivity was increased. Ninety-three percent of patients were followed for more than 48 months, and all patients reported daily stool elimination without recurrence of constipation.


CONCLUSIONS
The current study indicates that our technique is effective for surgical treatment of patients with Chagasic megacolon.
Nahas
Sergio C
SC
Department of Gastroenterology, Colorectal Surgery Division, University of São Paulo, School of Medicine, Rua Jabebira 136, 05602-020 São Paulo, SP, Brazil. caionahas@uol.com.br
Habr-Gama
Angelita
A
Nahas
Caio S Rizkallah
CS
Araujo
Sergio E Alonso
SE
Marques
Carlos F Sparapan
CF
Sobrado
Carlos W
CW
Bocchini
Sylvio F
SF
Kiss
Desiderio Roberto
DR
D001003:Anal Canal / Q000503:physiopathology; D000714:Anastomosis, Surgical; D014355:Chagas Disease / Q000150:complications* / Q000175:diagnosis; D012809:Colon, Sigmoid / Q000601:surgery*; D013505:Digestive System Surgical Procedures / Q000379:methods*; D006801:Humans; D007431:Intraoperative Complications; D008365:Manometry; D008531:Megacolon / Q000175:diagnosis / Q000469:parasitology / Q000503:physiopathology / Q000601:surgery*; D011183:Postoperative Complications; D012007:Rectum / Q000601:surgery*; D013528:Surgical Staplers