transanal muscle resection

Transanal muscle resection is used for posterior rectal sphincter resection. Congenital megacolon is a common malformation of the digestive tract. It is caused by the lack of ganglion cells in the distal segment of the colon, resulting in intestinal fistula, normal peristalsis of the intestine segment disappearing, forming functional intestinal obstruction, obstructing proximal intestinal dilatation. Fat. The length of the intestines varies from a few centimeters, sometimes to the entire colon, and even to the small intestine. The latter has serious clinical symptoms and is complicated to treat. The most common type is the sigmoid colon below the sacral segment, and the proximal intestine near the sacral segment gradually expands until the dilated segment is called the transition segment. There is also a lack of ganglion cells in this segment of the intestine. In the dilated segment of the intestine muscle layer hypertrophy, chronic inflammation of the mucosa, and even ulceration, degeneration and spasm of the intermuscular plexus and submucosal ganglion cells. The length of the dilatation segment is also inconsistent with the age of the visit, and then gradually transitions to the normal intestine. The main point of congenital megacolon surgery is to remove the sacral segment, the transitional segment and some of the dilated bowel segments that cannot restore normal function according to the characteristics of the above pathological changes. Treatment of diseases: congenital megacolon Indication Transanal muscle resection is not an abdominal cavity, no bowel resection and anastomosis, and less damage, only suitable for short megacolon, or as an auxiliary treatment for residual internal sphincter symptoms after other radical surgery. For some patients after this operation, some children can not resume spontaneous bowel movements. Therefore, some scholars believe that radical surgery should be performed after the diagnosis of ganglion cell megacolon, but this point is still controversial. Contraindications Congenital megacolon disease When the intestine segment is long, simply cutting the internal sphincter and partially removing the smooth muscle of the posterior wall of the rectum does not achieve a radical effect, so it is not applicable. This procedure is also not suitable for temporary treatment before radical surgery, because once it fails, severe adhesions in the anterior tibial space will bring great difficulties to the rectum. Surgical procedure 1. The sick child takes the lithotomy position, the buttocks are high, and the perineum is disinfected with 0.5% iodophor. 2. Anal anus is retracted with a retractor. 3. The incision made a transverse incision 0.5 cm above the dentate line, the rectal mucosa was cut, and the rectal mucosa was pulled up by the traction line to reveal the posterior rectal wall and the internal sphincter of the anus. 4. An electric anal sphincter and a rectal posterior wall muscle layer of 1 cm wide and 5 cm long were cut longitudinally with an electric knife. 5. The rectal mucosa was then repositioned and sutured with 4-0 absorbable sutures or 2-0 silk sutures. complication Recurrent symptom group: It is reported that the range of the posterior rectal muscle layer and the anal internal sphincter is difficult to grasp due to intraoperative resection, and local adhesion occurs after surgery, resulting in recurrence of postoperative constipation in some cases. If you are not good, you should switch to radical surgery.