Luis de la Torre
219 statements · 4 topics · summaries given as host listed separately
Featured statements
The problem is the muscular cuff. When you reach the muscular cuff and you can see here a huge, floppy and dilated colon. And you leave this muscular cuff, most probably the patient is going to have chronic obstruction, and this chronic obstruction is going to produce a chronic colitis.
quote ·
Colorectal / ARM & Hirschsprung
If you are in the right plane of dissection, this operation is almost bloodless.
quote ·
Colorectal / ARM & Hirschsprung
The columnar zone should be preserved for fecal control.
quote ·
Hirschsprung disease
To achieve the most accurate, functional, and anatomical surgery for Hirschsprung, you need good bowel (good irrigation, good pathology, no tension), caution in the blind zone (pelvis), and a perfect anastomosis (not too low, not too high, technically well-performed, preserving anal canal).
clinical ·
Hirschsprung disease
While waiting for frozen-section biopsy results, resect as much muscular cuff as possible and perform a myectomy on the posterior wall, resecting 1-2 cm in length and creating a short muscular cuff from below.
clinical ·
Total Colonic Aganglionosis
Patients with long-segment disease and massive megacolon are not good candidates for primary transanal pull-through because we need to remove these huge segments of chronic dilation which have poor motility.
clinical ·
Total Colonic Aganglionosis
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Luis's statements about Colorectal / ARM & Hirschsprung 100 statements
Open the Colorectal / ARM & Hirschsprung collection →
Surgical Procedures for Hirschsprung Disease
Statement
The Swenson technique was originally done in 3 stages: colostomy, then multiple biopsies to determine the exact length of aganglionic area, then pull-through.
Open
Statement
The Duhamel technique was proposed to avoid anterior dissection of the rectum after many surgeons caused damage to pelvic structures (vagina, urethra) with the Swenson technique.
Open
Statement
The Soave technique involved mucosectomy to leave a muscular cuff and pass the colon through the rectum, avoiding any dissection in the pelvis.
Open
Statement
In 1980, Philippine surgeons working in the United States published that they achieved primary endorectal pull-through for Hirschsprung patients.
Open
Statement
Henry Soave said you need to do very good irrigation before starting any surgical procedure for Hirschsprung disease.
Open
Statement
Laparoscopy for Hirschsprung is the same as laparotomy—it's the same Soave, Duhamel, or Swenson technique, just using different instruments.
Open
Statement
Laparoscopy for Hirschsprung is the same as laparotomy—it's the same Soave, Duhamel, or Swenson technique, just using different instruments.
Open
Statement
In many countries where laparoscopy is not common, surgeons continue using laparotomy and patients do well—it doesn't matter if they have laparotomy or laparoscopy.
Open
Statement
In many countries where laparoscopy is not common, surgeons continue using laparotomy and patients do well—it doesn't matter if they have laparotomy or laparoscopy.
Open
Statement
If you can do the Swenson procedure in 3 stages and the patient outcome is good, that's perfect—you don't need to do a transanal endorectal pull-through.
Open
Quotation
If you can do the Swenson procedure in 3 stages and the patient is, the outcome of the patient is well, it's perfect. You don't need to do a transanal endorectal pull-through or transanal full-thickness pull-through.
Open
Quotation
If you can do the Swenson procedure in 3 stages and the patient is, the outcome of the patient is well, it's perfect. You don't need to do a transanal endorectal pull-through or transanal full-thickness pull-through.
Open
Statement
If you can do the Swenson procedure in 3 stages and the patient outcome is good, that's perfect—you don't need to do a transanal endorectal pull-through.
Open
Quotation
It is very important. You need to have a very good radiologist. You need to have a very good pathologist and decide because at the end, the decision is not based just only in the pathology or radiology. The decision is taken from yourself. You are the surgeon and you need to take the decision.
Open
Quotation
It is very important. You need to have a very good radiologist. You need to have a very good pathologist and decide because at the end, the decision is not based just only in the pathology or radiology. The decision is taken from yourself. You are the surgeon and you need to take the decision.
Open
Quotation
Many surgeons do not recognize the anal canal or they not protect the anal canal during the pull-through.
Open
Quotation
Many surgeons do not recognize the anal canal or they not protect the anal canal during the pull-through.
Open
Statement
To do a good endorectal pull-through, you need to identify a very good plane of dissection and observe the circular fibers of the rectum that will become the rectal cuff.
Open
Statement
To do a good endorectal pull-through, you need to identify a very good plane of dissection and observe the circular fibers of the rectum that will become the rectal cuff.
Open
Statement
If you are in the right plane of dissection during endorectal pull-through, the operation is almost bloodless.
Open
Statement
If you are in the right plane of dissection during endorectal pull-through, the operation is almost bloodless.
Open
Statement
When you leave a muscular cuff with a huge, floppy, dilated colon, the patient will most probably have chronic obstruction, which produces chronic colitis.
Open
Statement
When you leave a muscular cuff with a huge, floppy, dilated colon, the patient will most probably have chronic obstruction, which produces chronic colitis.
Open
Statement
To create the muscular cuff, place two sutures: one taking mucosa and muscular cuff, the other taking just muscular cuff, then cut in between.
Open
Statement
To create the muscular cuff, place two sutures: one taking mucosa and muscular cuff, the other taking just muscular cuff, then cut in between.
Open
Statement
After opening the muscular cuff, you can see the mesentery from the posterior wall; ligate and cut the vascular vessels to gain more length of colon.
Open
Statement
After opening the muscular cuff, you can see the mesentery from the posterior wall; ligate and cut the vascular vessels to gain more length of colon.
Open
Statement
While waiting for frozen-section biopsy results, resect as much muscular cuff as possible and perform a myectomy on the posterior wall, resecting 1-2 cm in length and creating a short muscular cuff from below.
Open
Statement
While waiting for frozen-section biopsy results, resect as much muscular cuff as possible and perform a myectomy on the posterior wall, resecting 1-2 cm in length and creating a short muscular cuff from below.
Open
Statement
For frozen-section biopsies during Hirschsprung surgery, always send full-thickness biopsies, never small seromuscular biopsies, because pathologists suffer with very small biopsies on frozen section.
Open
Statement
For frozen-section biopsies during Hirschsprung surgery, always send full-thickness biopsies, never small seromuscular biopsies, because pathologists suffer with very small biopsies on frozen section.
Open
Statement
One of the most common problems in endorectal pull-through is leaving a large muscular cuff, which causes obstruction.
Open
Statement
One of the most common problems in endorectal pull-through is leaving a large muscular cuff, which causes obstruction.
Open
Statement
The anastomosis should be performed with the most perfect technique possible, using fine sutures (5-0 or 6-0 Vicryl).
Open
Statement
The anastomosis should be performed with the most perfect technique possible, using fine sutures (5-0 or 6-0 Vicryl).
Open
Statement
To perform the anastomosis, remove the Lone Star retractor hooks so you can see the anal canal again and ensure proper placement.
Open
Statement
To perform the anastomosis, remove the Lone Star retractor hooks so you can see the anal canal again and ensure proper placement.
Open
Statement
When doing rectal irrigation for Hirschsprung, if the patient improves immediately, they are a candidate for transanal approach.
Open
Statement
When doing rectal irrigation for Hirschsprung, if the patient improves immediately, they are a candidate for transanal approach.
Open
Statement
Patients with long-segment or total colonic aganglionosis do not improve with rectal irrigation.
Open
Statement
Patients with long-segment or total colonic aganglionosis do not improve with rectal irrigation.
Open
Statement
Patients with late presentation and chronic dilation of the colon (massive megacolon) are not suitable for primary transanal pull-through.
Open
Statement
Patients with late presentation and chronic dilation of the colon (massive megacolon) are not suitable for primary transanal pull-through.
Open
Statement
Chronic dilation of the colon has poor motility, so these segments need to be resected.
Open
Statement
Chronic dilation of the colon has poor motility, so these segments need to be resected.
Open
Statement
To achieve the most accurate, functional, and anatomical surgery for Hirschsprung, you need good bowel (good irrigation, good pathology, no tension), caution in the blind zone (pelvis), and a perfect anastomosis (not too low, not too high, technically well-performed, preserving anal canal).
Open
Statement
To achieve the most accurate, functional, and anatomical surgery for Hirschsprung, you need good bowel (good irrigation, good pathology, no tension), caution in the blind zone (pelvis), and a perfect anastomosis (not too low, not too high, technically well-performed, preserving anal canal).
Open
Statement
The anal canal is composed of three zones: anoderm (squamous epithelium), the area where the pectinate line lives, and the columnar zone.
Open
Statement
The anal canal is composed of three zones: anoderm (squamous epithelium), the area where the pectinate line lives, and the columnar zone.
Open
Statement
Patients who have had different Hirschsprung techniques (transanal, laparoscopic, Soave, Swenson) and have none of these anal canal elements are fecally incontinent.
Open
Statement
Patients who have had different Hirschsprung techniques (transanal, laparoscopic, Soave, Swenson) and have none of these anal canal elements are fecally incontinent.
Open
Statement
Patients with destroyed anal canals from Hirschsprung surgery do not have enterocolitis but are fecally incontinent.
Open
Statement
Patients with destroyed anal canals from Hirschsprung surgery do not have enterocolitis but are fecally incontinent.
Open
Statement
It is prohibited to do the anastomosis below the columnar zone—if you do, the patient will be fecally incontinent.
Open
Quotation
It's prohibited to do the anastomosis below this line. If you do the anastomosis below this line, the patient will be fecal incontinent.
Open
Quotation
It's prohibited to do the anastomosis below this line. If you do the anastomosis below this line, the patient will be fecal incontinent.
Open
Statement
It is prohibited to do the anastomosis below the columnar zone—if you do, the patient will be fecally incontinent.
Open
Statement
If you use all of the anal canal shadow area for anastomosis, the patient will have full fecal incontinence; if you use 50%, partial incontinence.
Open
Statement
If you use all of the anal canal shadow area for anastomosis, the patient will have full fecal incontinence; if you use 50%, partial incontinence.
Open
Outcomes and Complications in Hirschsprung Disease
Statement
Colitis in Hirschsprung disease is always associated with obstructive symptoms; future research should focus on obstructive etiologies.
Open
Statement
Colitis in Hirschsprung disease is always associated with obstructive symptoms; future research should focus on obstructive etiologies.
Open
Hirschsprung Disease: Surgical Procedures
Statement
To do a very good endorectal pull-through, you need to identify a very good plane of dissection and observe the circular fibers of the rectum that will become the rectal cuff.
Open
Statement
If you are in the right plane of dissection during endorectal pull-through, the operation is almost bloodless.
Open
Quotation
The problem is the muscular cuff. When you reach the muscular cuff and you can see here a huge, floppy and dilated colon. And you leave this muscular cuff, most probably the patient is going to have chronic obstruction, and this chronic obstruction is going to produce a chronic colitis.
Open
Statement
When you leave a large muscular cuff, the patient will most probably have chronic obstruction, and this chronic obstruction will produce chronic colitis.
Open
Statement
A posterior myectomy should be performed, resecting 1-2 centimeters in length of the muscular cuff to create a short muscular cuff from below.
Open
Statement
Full-thickness biopsies should be sent for frozen section, not small seromuscular biopsies, because pathologists suffer when you send very small biopsies for frozen section.
Open
Statement
One of the most common problems in endorectal pull-through is leaving a large cuff, which causes obstruction.
Open
Statement
The anastomosis should be performed with the most perfect technique possible using fine sutures, 5-0 or 6-0 Vicryl.
Open
Statement
Patients who improve with rectal irrigation most probably suffer from Hirschsprung disease.
Open
Quotation
Long segments, they don't improve with irrigation. Long segments are, I think is another big problem.
Open
Statement
Long-segment Hirschsprung disease patients do not improve with irrigation—they are totally different and represent another big problem.
Open
Statement
Patients with long-segment disease and massive megacolon are not good candidates for primary transanal pull-through because we need to remove these huge segments of chronic dilation which have poor motility.
Open
Statement
The anal canal is composed of three clear zones: the anoderm with squamous epithelium, the area where the pectinate line lives, and the columnar zone.
Open
Statement
Patients who have had the anal canal removed through different techniques are fecally incontinent, and interestingly, these patients also don't have enterocolitis.
Open
Quotation
It's prohibited to do the anastomosis below this line. If you do the anastomosis below this line, the patient will be fecal incontinent.
Open
Statement
If you do the anastomosis below the columnar zone, the patient will be fecally incontinent—using 100% of that area results in full fecal incontinence, using 50% results in partial fecal incontinence.
Open
Quotation
If you use all this shadow area, the patient is going to be full fecal incontinence. If you use 50%, you're going to have partial fecal incontinence.
Open
Hirschsprung Disease: Cases and Complications
Statement
Obstructive colitis in Hirschsprung disease exists on a spectrum of severity, and future research should focus on obstructive etiologies to understand this complication.
Open
Statement
Obstructive colitis in Hirschsprung disease exists on a spectrum of severity, and future research should focus on obstructive etiologies to understand this complication.
Open
Error Traps and Culture of Safety in Hirschsprung Disease
Statement
These errors are the source of pull-throughs in patients with idiopathic constipation
Open
Statement
Many errors still happen in patients with Hirschsprung, resulting in complications and mortality
Open
Statement
The most common error in these patients are the false diagnosis of Hirschsprung because of an inadequate biopsy
Open
Statement
Incorrect performance of rectal irrigations during medical treatment is a common error
Open
Statement
Damage of the anal canal during mapping the colon with multiple biopsies is a common error
Open
Statement
Missing the rectal biopsy to confirm Hirschsprung disease in patients with low intestinal obstruction is a common error
Open
Statement
These errors result in multiple bowel resection with loss of significant amount of colon
Open
Quotation
Many errors still happen in patients with Hirshprung, resulting in complications and mortality.
Open
Quotation
If we avoid these errors, we can improve the outcome and the quality of life of these patients.
Open
Luis's statements about Enterocolitis 2 statements
Open the Enterocolitis collection →
Outcomes and Complications in Hirschsprung Disease
Statement
Colitis in Hirschsprung disease is always associated with obstructive symptoms; future research should focus on obstructive etiologies.
Open
Hirschsprung Disease: Cases and Complications
Statement
Obstructive colitis in Hirschsprung disease exists on a spectrum of severity, and future research should focus on obstructive etiologies to understand this complication.
Open
Luis's statements about Hirschsprung disease 68 statements
Open the Hirschsprung disease collection →
Surgical Procedures for Hirschsprung Disease
Statement
The Swenson technique was originally done in 3 stages: colostomy, then multiple biopsies to determine the exact length of aganglionic area, then pull-through.
Open
Statement
The Duhamel technique was proposed to avoid anterior dissection of the rectum after many surgeons caused damage to pelvic structures (vagina, urethra) with the Swenson technique.
Open
Statement
The Soave technique involved mucosectomy to leave a muscular cuff and pass the colon through the rectum, avoiding any dissection in the pelvis.
Open
Statement
In 1980, Philippine surgeons working in the United States published that they achieved primary endorectal pull-through for Hirschsprung patients.
Open
Statement
Henry Soave said you need to do very good irrigation before starting any surgical procedure for Hirschsprung disease.
Open
Statement
Laparoscopy for Hirschsprung is the same as laparotomy—it's the same Soave, Duhamel, or Swenson technique, just using different instruments.
Open
Statement
In many countries where laparoscopy is not common, surgeons continue using laparotomy and patients do well—it doesn't matter if they have laparotomy or laparoscopy.
Open
Quotation
If you can do the Swenson procedure in 3 stages and the patient is, the outcome of the patient is well, it's perfect. You don't need to do a transanal endorectal pull-through or transanal full-thickness pull-through.
Open
Statement
If you can do the Swenson procedure in 3 stages and the patient outcome is good, that's perfect—you don't need to do a transanal endorectal pull-through.
Open
Quotation
It is very important. You need to have a very good radiologist. You need to have a very good pathologist and decide because at the end, the decision is not based just only in the pathology or radiology. The decision is taken from yourself. You are the surgeon and you need to take the decision.
Open
Quotation
Many surgeons do not recognize the anal canal or they not protect the anal canal during the pull-through.
Open
Statement
To do a good endorectal pull-through, you need to identify a very good plane of dissection and observe the circular fibers of the rectum that will become the rectal cuff.
Open
Statement
If you are in the right plane of dissection during endorectal pull-through, the operation is almost bloodless.
Open
Statement
When you leave a muscular cuff with a huge, floppy, dilated colon, the patient will most probably have chronic obstruction, which produces chronic colitis.
Open
Statement
To create the muscular cuff, place two sutures: one taking mucosa and muscular cuff, the other taking just muscular cuff, then cut in between.
Open
Statement
After opening the muscular cuff, you can see the mesentery from the posterior wall; ligate and cut the vascular vessels to gain more length of colon.
Open
Statement
While waiting for frozen-section biopsy results, resect as much muscular cuff as possible and perform a myectomy on the posterior wall, resecting 1-2 cm in length and creating a short muscular cuff from below.
Open
Statement
For frozen-section biopsies during Hirschsprung surgery, always send full-thickness biopsies, never small seromuscular biopsies, because pathologists suffer with very small biopsies on frozen section.
Open
Statement
One of the most common problems in endorectal pull-through is leaving a large muscular cuff, which causes obstruction.
Open
Statement
The anastomosis should be performed with the most perfect technique possible, using fine sutures (5-0 or 6-0 Vicryl).
Open
Statement
To perform the anastomosis, remove the Lone Star retractor hooks so you can see the anal canal again and ensure proper placement.
Open
Statement
When doing rectal irrigation for Hirschsprung, if the patient improves immediately, they are a candidate for transanal approach.
Open
Statement
Patients with long-segment or total colonic aganglionosis do not improve with rectal irrigation.
Open
Statement
Patients with late presentation and chronic dilation of the colon (massive megacolon) are not suitable for primary transanal pull-through.
Open
Statement
Chronic dilation of the colon has poor motility, so these segments need to be resected.
Open
Statement
To achieve the most accurate, functional, and anatomical surgery for Hirschsprung, you need good bowel (good irrigation, good pathology, no tension), caution in the blind zone (pelvis), and a perfect anastomosis (not too low, not too high, technically well-performed, preserving anal canal).
Open
Statement
The anal canal is composed of three zones: anoderm (squamous epithelium), the area where the pectinate line lives, and the columnar zone.
Open
Statement
Patients who have had different Hirschsprung techniques (transanal, laparoscopic, Soave, Swenson) and have none of these anal canal elements are fecally incontinent.
Open
Statement
Patients with destroyed anal canals from Hirschsprung surgery do not have enterocolitis but are fecally incontinent.
Open
Quotation
It's prohibited to do the anastomosis below this line. If you do the anastomosis below this line, the patient will be fecal incontinent.
Open
Statement
It is prohibited to do the anastomosis below the columnar zone—if you do, the patient will be fecally incontinent.
Open
Statement
If you use all of the anal canal shadow area for anastomosis, the patient will have full fecal incontinence; if you use 50%, partial incontinence.
Open
Hirschsprung Disease: Surgical Procedures
Statement
To do a very good endorectal pull-through, you need to identify a very good plane of dissection and observe the circular fibers of the rectum that will become the rectal cuff.
Open
Statement
If you are in the right plane of dissection during endorectal pull-through, the operation is almost bloodless.
Open
Quotation
The problem is the muscular cuff. When you reach the muscular cuff and you can see here a huge, floppy and dilated colon. And you leave this muscular cuff, most probably the patient is going to have chronic obstruction, and this chronic obstruction is going to produce a chronic colitis.
Open
Statement
When you leave a large muscular cuff, the patient will most probably have chronic obstruction, and this chronic obstruction will produce chronic colitis.
Open
Statement
A posterior myectomy should be performed, resecting 1-2 centimeters in length of the muscular cuff to create a short muscular cuff from below.
Open
Statement
Full-thickness biopsies should be sent for frozen section, not small seromuscular biopsies, because pathologists suffer when you send very small biopsies for frozen section.
Open
Statement
One of the most common problems in endorectal pull-through is leaving a large cuff, which causes obstruction.
Open
Statement
The anastomosis should be performed with the most perfect technique possible using fine sutures, 5-0 or 6-0 Vicryl.
Open
Statement
Patients who improve with rectal irrigation most probably suffer from Hirschsprung disease.
Open
Quotation
Long segments, they don't improve with irrigation. Long segments are, I think is another big problem.
Open
Statement
Long-segment Hirschsprung disease patients do not improve with irrigation—they are totally different and represent another big problem.
Open
Statement
Patients with long-segment disease and massive megacolon are not good candidates for primary transanal pull-through because we need to remove these huge segments of chronic dilation which have poor motility.
Open
Statement
The anal canal is composed of three clear zones: the anoderm with squamous epithelium, the area where the pectinate line lives, and the columnar zone.
Open
Statement
Patients who have had the anal canal removed through different techniques are fecally incontinent, and interestingly, these patients also don't have enterocolitis.
Open
Quotation
It's prohibited to do the anastomosis below this line. If you do the anastomosis below this line, the patient will be fecal incontinent.
Open
Statement
If you do the anastomosis below the columnar zone, the patient will be fecally incontinent—using 100% of that area results in full fecal incontinence, using 50% results in partial fecal incontinence.
Open
Quotation
If you use all this shadow area, the patient is going to be full fecal incontinence. If you use 50%, you're going to have partial fecal incontinence.
Open
Error Traps and Culture of Safety in Hirschsprung Disease
Statement
Many errors still happen in patients with Hirschsprung, resulting in complications and mortality
Open
Statement
Incorrect performance of rectal irrigations during medical treatment is a common error
Open
Statement
Damage of the anal canal during mapping the colon with multiple biopsies is a common error
Open
Statement
Missing the rectal biopsy to confirm Hirschsprung disease in patients with low intestinal obstruction is a common error
Open
Statement
These errors are the source of pull-throughs in patients with idiopathic constipation
Open
Statement
These errors result in multiple bowel resection with loss of significant amount of colon
Open
Quotation
Many errors still happen in patients with Hirshprung, resulting in complications and mortality.
Open
Quotation
If we avoid these errors, we can improve the outcome and the quality of life of these patients.
Open
Statement
The most common error in these patients are the false diagnosis of Hirschsprung because of an inadequate biopsy
Open
Luis's statements about Total Colonic Aganglionosis 49 statements
Open the Total Colonic Aganglionosis collection →
Surgical Procedures for Hirschsprung Disease
Statement
Laparoscopy for Hirschsprung is the same as laparotomy—it's the same Soave, Duhamel, or Swenson technique, just using different instruments.
Open
Statement
In many countries where laparoscopy is not common, surgeons continue using laparotomy and patients do well—it doesn't matter if they have laparotomy or laparoscopy.
Open
Quotation
If you can do the Swenson procedure in 3 stages and the patient is, the outcome of the patient is well, it's perfect. You don't need to do a transanal endorectal pull-through or transanal full-thickness pull-through.
Open
Statement
If you can do the Swenson procedure in 3 stages and the patient outcome is good, that's perfect—you don't need to do a transanal endorectal pull-through.
Open
Quotation
It is very important. You need to have a very good radiologist. You need to have a very good pathologist and decide because at the end, the decision is not based just only in the pathology or radiology. The decision is taken from yourself. You are the surgeon and you need to take the decision.
Open
Quotation
Many surgeons do not recognize the anal canal or they not protect the anal canal during the pull-through.
Open
Statement
To do a good endorectal pull-through, you need to identify a very good plane of dissection and observe the circular fibers of the rectum that will become the rectal cuff.
Open
Statement
If you are in the right plane of dissection during endorectal pull-through, the operation is almost bloodless.
Open
Statement
When you leave a muscular cuff with a huge, floppy, dilated colon, the patient will most probably have chronic obstruction, which produces chronic colitis.
Open
Statement
To create the muscular cuff, place two sutures: one taking mucosa and muscular cuff, the other taking just muscular cuff, then cut in between.
Open
Statement
After opening the muscular cuff, you can see the mesentery from the posterior wall; ligate and cut the vascular vessels to gain more length of colon.
Open
Statement
While waiting for frozen-section biopsy results, resect as much muscular cuff as possible and perform a myectomy on the posterior wall, resecting 1-2 cm in length and creating a short muscular cuff from below.
Open
Statement
For frozen-section biopsies during Hirschsprung surgery, always send full-thickness biopsies, never small seromuscular biopsies, because pathologists suffer with very small biopsies on frozen section.
Open
Statement
One of the most common problems in endorectal pull-through is leaving a large muscular cuff, which causes obstruction.
Open
Statement
The anastomosis should be performed with the most perfect technique possible, using fine sutures (5-0 or 6-0 Vicryl).
Open
Statement
To perform the anastomosis, remove the Lone Star retractor hooks so you can see the anal canal again and ensure proper placement.
Open
Statement
When doing rectal irrigation for Hirschsprung, if the patient improves immediately, they are a candidate for transanal approach.
Open
Statement
Patients with long-segment or total colonic aganglionosis do not improve with rectal irrigation.
Open
Statement
Patients with late presentation and chronic dilation of the colon (massive megacolon) are not suitable for primary transanal pull-through.
Open
Statement
Chronic dilation of the colon has poor motility, so these segments need to be resected.
Open
Statement
To achieve the most accurate, functional, and anatomical surgery for Hirschsprung, you need good bowel (good irrigation, good pathology, no tension), caution in the blind zone (pelvis), and a perfect anastomosis (not too low, not too high, technically well-performed, preserving anal canal).
Open
Statement
The anal canal is composed of three zones: anoderm (squamous epithelium), the area where the pectinate line lives, and the columnar zone.
Open
Statement
Patients who have had different Hirschsprung techniques (transanal, laparoscopic, Soave, Swenson) and have none of these anal canal elements are fecally incontinent.
Open
Statement
Patients with destroyed anal canals from Hirschsprung surgery do not have enterocolitis but are fecally incontinent.
Open
Quotation
It's prohibited to do the anastomosis below this line. If you do the anastomosis below this line, the patient will be fecal incontinent.
Open
Statement
It is prohibited to do the anastomosis below the columnar zone—if you do, the patient will be fecally incontinent.
Open
Statement
If you use all of the anal canal shadow area for anastomosis, the patient will have full fecal incontinence; if you use 50%, partial incontinence.
Open
Hirschsprung Disease: Surgical Procedures
Statement
To do a very good endorectal pull-through, you need to identify a very good plane of dissection and observe the circular fibers of the rectum that will become the rectal cuff.
Open
Statement
If you are in the right plane of dissection during endorectal pull-through, the operation is almost bloodless.
Open
Statement
When you leave a large muscular cuff, the patient will most probably have chronic obstruction, and this chronic obstruction will produce chronic colitis.
Open
Quotation
The problem is the muscular cuff. When you reach the muscular cuff and you can see here a huge, floppy and dilated colon. And you leave this muscular cuff, most probably the patient is going to have chronic obstruction, and this chronic obstruction is going to produce a chronic colitis.
Open
Statement
A posterior myectomy should be performed, resecting 1-2 centimeters in length of the muscular cuff to create a short muscular cuff from below.
Open
Statement
Full-thickness biopsies should be sent for frozen section, not small seromuscular biopsies, because pathologists suffer when you send very small biopsies for frozen section.
Open
Statement
One of the most common problems in endorectal pull-through is leaving a large cuff, which causes obstruction.
Open
Statement
The anastomosis should be performed with the most perfect technique possible using fine sutures, 5-0 or 6-0 Vicryl.
Open
Statement
Patients who improve with rectal irrigation most probably suffer from Hirschsprung disease.
Open
Statement
Long-segment Hirschsprung disease patients do not improve with irrigation—they are totally different and represent another big problem.
Open
Quotation
Long segments, they don't improve with irrigation. Long segments are, I think is another big problem.
Open
Statement
Patients with long-segment disease and massive megacolon are not good candidates for primary transanal pull-through because we need to remove these huge segments of chronic dilation which have poor motility.
Open
Statement
The anal canal is composed of three clear zones: the anoderm with squamous epithelium, the area where the pectinate line lives, and the columnar zone.
Open
Statement
Patients who have had the anal canal removed through different techniques are fecally incontinent, and interestingly, these patients also don't have enterocolitis.
Open
Quotation
It's prohibited to do the anastomosis below this line. If you do the anastomosis below this line, the patient will be fecal incontinent.
Open
Statement
If you do the anastomosis below the columnar zone, the patient will be fecally incontinent—using 100% of that area results in full fecal incontinence, using 50% results in partial fecal incontinence.
Open
Quotation
If you use all this shadow area, the patient is going to be full fecal incontinence. If you use 50%, you're going to have partial fecal incontinence.
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Summaries Luis gave as host · 10 summaries
Recaps of other experts' statements, not Luis's own clinical position.
Summaries Luis gave as host · Colorectal / ARM & Hirschsprung 5 summaries
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Surgical Procedures for Hirschsprung Disease
Host summary
Luis de la Torre summarizes what Dr. Richard Krauss said: The Swenson technique was originally done in 3 stages: colostomy, then multiple biopsies to determine the exact length of aganglionic area, then pull-through.
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Host summary
Luis de la Torre summarizes what Dr. Richard Krauss said: The Duhamel technique was proposed to avoid anterior dissection of the rectum after many surgeons caused damage to pelvic structures (vagina, urethra) with the Swenson technique.
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Host summary
Luis de la Torre summarizes what Dr. Richard Krauss said: The Soave technique involved mucosectomy to leave a muscular cuff and pass the colon through the rectum, avoiding any dissection in the pelvis.
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Host summary
Luis de la Torre summarizes what Dr. Richard Krauss said: In 1980, Philippine surgeons working in the United States published that they achieved primary endorectal pull-through for Hirschsprung patients.
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Host summary
Luis de la Torre summarizes what Dr. Richard Krauss said: Henry Soave said you need to do very good irrigation before starting any surgical procedure for Hirschsprung disease.
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Summaries Luis gave as host · Total Colonic Aganglionosis 5 summaries
Open the Total Colonic Aganglionosis collection →
Surgical Procedures for Hirschsprung Disease
Host summary
Luis de la Torre summarizes what Dr. Richard Krauss said: The Swenson technique was originally done in 3 stages: colostomy, then multiple biopsies to determine the exact length of aganglionic area, then pull-through.
Open
Host summary
Luis de la Torre summarizes what Dr. Richard Krauss said: The Duhamel technique was proposed to avoid anterior dissection of the rectum after many surgeons caused damage to pelvic structures (vagina, urethra) with the Swenson technique.
Open
Host summary
Luis de la Torre summarizes what Dr. Richard Krauss said: The Soave technique involved mucosectomy to leave a muscular cuff and pass the colon through the rectum, avoiding any dissection in the pelvis.
Open
Host summary
Luis de la Torre summarizes what Dr. Richard Krauss said: In 1980, Philippine surgeons working in the United States published that they achieved primary endorectal pull-through for Hirschsprung patients.
Open
Host summary
Luis de la Torre summarizes what Dr. Richard Krauss said: Henry Soave said you need to do very good irrigation before starting any surgical procedure for Hirschsprung disease.
Open