Surgical treatment of Chagas megacolon. Critical analysis of outcome in operative methods.
OBJECTIVE
Surgical treatment of chagasic megacolon has suffered innumerable transformations over the years. Poor knowledge of the disease physiopathology is one of the reasons.


METHODS
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.


CONCLUSIONS
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.
Division of Coloproctology, Department of Surgery and Anatomy, Ribeirão Preto Faculty of Medicine, University of São Paulo, SP, Brazil. ricardolsgarcia@uol.com.br
Ricardo Luiz Santos
RL
Garcia
Bruna Meyer R de
BM
Matos
Omar
O
Féres
José Joaquim Ribeiro da
JJ
Rocha
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014355:Chagas Disease / Q000150:complications / Q000601:surgery*; D003082:Colectomy / Q000009:adverse effects / Q000379:methods; D012809:Colon, Sigmoid / Q000601:surgery*; D003248:Constipation / Q000209:etiology; D005260:Female; D006801:Humans; D008297:Male; D008531:Megacolon / Q000209:etiology / Q000601:surgery*; D008875:Middle Aged; D012007:Rectum / Q000601:surgery*; D012008:Recurrence; D012189:Retrospective Studies; D013529:Surgical Wound Dehiscence / Q000209:etiology; D016896:Treatment Outcome; D055815:Young Adult