TRANS-RECTAL ABDOMINALLY ASSISTED PULL THROUGH OPERATION; A NEW MODIFICATION OF SOAVE S OPERATION FOR TREATMENT OF IDIOPATHIC MEGARECTUM AND MEGACOLON

Aim: Idiopathic megarectum and/or megacolon with slow-transit constipation refractory to medical management is an indication for surgery. Non of the surgical options available proved satisfactory. Trans- Rectal Abdominally Assisted Pull Through Operation, is a new modification of the Soave s operation to avoid deep pelvic dissection, and injury of the short vasa recta in adults. Methods: Thirty patients were included in the study with the colonic transit test greater than 96 hours, with the barium enema showing megarectum and/or mega- left side colon, and anal manometry was shown to be normal. Patients diagnosed with chronic idiopathic constipation according to the scoring system reported by Altamore et al.(15) which was performed for all patients preoperative, one month after stoma closure, and one year postoperative. Anal myectomy was done for all patients, 25 patients did not improve and required trans-rectal abdominally assisted pull through operation. Results: Patients who were operated upon by abdominally assisted pull through operation showed significant postoperative improvement of their constipation scores after three months, and one year respectively. Conclusion: Trans-rectal abdominally assisted pull through operation is a promising new technique in patients with medically resistant mega-rectum showing good short term results but still long term form follow up awaited