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.
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.
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.
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.
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.
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.
clinicalThe Swenson technique was originally done in 3 stages: colostomy, then multiple biopsies to determine the exact length of aganglionic area, then pull-through.↗
▶Ep 21 · 31:32
host_summaryThe Swenson technique was originally done in 3 stages: colostomy, then multiple biopsies to determine the exact length of aganglionic area, then pull-through.↗
▶Ep 21 · 32:13
host_summaryThe 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.↗
▶Ep 21 · 32:13
clinicalThe 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.↗
▶Ep 21 · 32:49
clinicalThe Soave technique involved mucosectomy to leave a muscular cuff and pass the colon through the rectum, avoiding any dissection in the pelvis.↗
▶Ep 21 · 32:49
host_summaryThe Soave technique involved mucosectomy to leave a muscular cuff and pass the colon through the rectum, avoiding any dissection in the pelvis.↗
▶Ep 21 · 33:35
host_summaryIn 1980, Philippine surgeons working in the United States published that they achieved primary endorectal pull-through for Hirschsprung patients.↗
▶Ep 21 · 33:35
clinicalIn 1980, Philippine surgeons working in the United States published that they achieved primary endorectal pull-through for Hirschsprung patients.↗
▶Ep 21 · 34:05
clinicalHenry Soave said you need to do very good irrigation before starting any surgical procedure for Hirschsprung disease.↗
▶Ep 21 · 34:05
host_summaryHenry Soave said you need to do very good irrigation before starting any surgical procedure for Hirschsprung disease.↗
▶Ep 21 · 34:35
opinionLaparoscopy for Hirschsprung is the same as laparotomy—it's the same Soave, Duhamel, or Swenson technique, just using different instruments.↗
▶Ep 21 · 34:35
opinionLaparoscopy for Hirschsprung is the same as laparotomy—it's the same Soave, Duhamel, or Swenson technique, just using different instruments.↗
▶Ep 21 · 35:01
opinionIn 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.↗
▶Ep 21 · 35:01
opinionIn 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.↗
▶Ep 21 · 35:43
opinionIf 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.↗
▶Ep 21 · 35:43
opinionIf 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.↗
▶Ep 21 · 35:43
quoteIf 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.↗
▶Ep 21 · 35:43
quoteIf 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.↗
▶Ep 21 · 39:18
quoteIt 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.↗
▶Ep 21 · 39:18
quoteIt 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.↗
▶Ep 21 · 41:42
quoteMany surgeons do not recognize the anal canal or they not protect the anal canal during the pull-through.↗
▶Ep 21 · 41:42
quoteMany surgeons do not recognize the anal canal or they not protect the anal canal during the pull-through.↗
▶Ep 21 · 42:15
clinicalTo 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.↗
▶Ep 21 · 42:15
clinicalTo 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.↗
▶Ep 21 · 42:36
clinicalIf you are in the right plane of dissection during endorectal pull-through, the operation is almost bloodless.↗
▶Ep 21 · 42:36
clinicalIf you are in the right plane of dissection during endorectal pull-through, the operation is almost bloodless.↗
▶Ep 21 · 42:55
clinicalWhen you leave a muscular cuff with a huge, floppy, dilated colon, the patient will most probably have chronic obstruction, which produces chronic colitis.↗
▶Ep 21 · 42:55
clinicalWhen you leave a muscular cuff with a huge, floppy, dilated colon, the patient will most probably have chronic obstruction, which produces chronic colitis.↗
▶Ep 21 · 43:24
clinicalTo create the muscular cuff, place two sutures: one taking mucosa and muscular cuff, the other taking just muscular cuff, then cut in between.↗
▶Ep 21 · 43:24
clinicalTo create the muscular cuff, place two sutures: one taking mucosa and muscular cuff, the other taking just muscular cuff, then cut in between.↗
▶Ep 21 · 43:51
clinicalAfter 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.↗
▶Ep 21 · 43:51
clinicalAfter 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.↗
▶Ep 21 · 44:30
clinicalWhile 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.↗
▶Ep 21 · 44:30
clinicalWhile 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.↗
▶Ep 21 · 51:39
clinicalFor 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.↗
▶Ep 21 · 51:39
clinicalFor 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.↗
▶Ep 21 · 52:57
clinicalOne of the most common problems in endorectal pull-through is leaving a large muscular cuff, which causes obstruction.↗
▶Ep 21 · 52:57
clinicalOne of the most common problems in endorectal pull-through is leaving a large muscular cuff, which causes obstruction.↗
▶Ep 21 · 53:50
clinicalThe anastomosis should be performed with the most perfect technique possible, using fine sutures (5-0 or 6-0 Vicryl).↗
▶Ep 21 · 53:50
clinicalThe anastomosis should be performed with the most perfect technique possible, using fine sutures (5-0 or 6-0 Vicryl).↗
▶Ep 21 · 54:14
clinicalTo perform the anastomosis, remove the Lone Star retractor hooks so you can see the anal canal again and ensure proper placement.↗
▶Ep 21 · 54:14
clinicalTo perform the anastomosis, remove the Lone Star retractor hooks so you can see the anal canal again and ensure proper placement.↗
▶Ep 21 · 55:35
clinicalWhen doing rectal irrigation for Hirschsprung, if the patient improves immediately, they are a candidate for transanal approach.↗
▶Ep 21 · 55:35
clinicalWhen doing rectal irrigation for Hirschsprung, if the patient improves immediately, they are a candidate for transanal approach.↗
▶Ep 21 · 1:00:03
clinicalPatients with long-segment or total colonic aganglionosis do not improve with rectal irrigation.↗
▶Ep 21 · 1:00:03
clinicalPatients with long-segment or total colonic aganglionosis do not improve with rectal irrigation.↗
▶Ep 21 · 1:01:34
clinicalPatients with late presentation and chronic dilation of the colon (massive megacolon) are not suitable for primary transanal pull-through.↗
▶Ep 21 · 1:01:34
clinicalPatients with late presentation and chronic dilation of the colon (massive megacolon) are not suitable for primary transanal pull-through.↗
▶Ep 21 · 1:02:18
clinicalChronic dilation of the colon has poor motility, so these segments need to be resected.↗
▶Ep 21 · 1:02:18
clinicalChronic dilation of the colon has poor motility, so these segments need to be resected.↗
▶Ep 21 · 1:02:47
clinicalTo 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).↗
▶Ep 21 · 1:02:47
clinicalTo 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).↗
▶Ep 21 · 1:04:05
clinicalThe anal canal is composed of three zones: anoderm (squamous epithelium), the area where the pectinate line lives, and the columnar zone.↗
▶Ep 21 · 1:04:05
clinicalThe anal canal is composed of three zones: anoderm (squamous epithelium), the area where the pectinate line lives, and the columnar zone.↗
▶Ep 21 · 1:04:32
clinicalThe columnar zone should be preserved for fecal control.↗
▶Ep 21 · 1:04:32
clinicalThe columnar zone should be preserved for fecal control.↗
▶Ep 21 · 1:04:53
clinicalPatients who have had different Hirschsprung techniques (transanal, laparoscopic, Soave, Swenson) and have none of these anal canal elements are fecally incontinent.↗
▶Ep 21 · 1:04:53
clinicalPatients who have had different Hirschsprung techniques (transanal, laparoscopic, Soave, Swenson) and have none of these anal canal elements are fecally incontinent.↗
▶Ep 21 · 1:05:10
clinicalPatients with destroyed anal canals from Hirschsprung surgery do not have enterocolitis but are fecally incontinent.↗
▶Ep 21 · 1:05:10
clinicalPatients with destroyed anal canals from Hirschsprung surgery do not have enterocolitis but are fecally incontinent.↗
▶Ep 21 · 1:06:09
clinicalIt is prohibited to do the anastomosis below the columnar zone—if you do, the patient will be fecally incontinent.↗
▶Ep 21 · 1:06:09
clinicalIt is prohibited to do the anastomosis below the columnar zone—if you do, the patient will be fecally incontinent.↗
▶Ep 21 · 1:06:09
quoteIt's prohibited to do the anastomosis below this line. If you do the anastomosis below this line, the patient will be fecal incontinent.↗
▶Ep 21 · 1:06:09
quoteIt's prohibited to do the anastomosis below this line. If you do the anastomosis below this line, the patient will be fecal incontinent.↗
▶Ep 21 · 1:06:30
clinicalIf you use all of the anal canal shadow area for anastomosis, the patient will have full fecal incontinence; if you use 50%, partial incontinence.↗
▶Ep 21 · 1:06:30
clinicalIf you use all of the anal canal shadow area for anastomosis, the patient will have full fecal incontinence; if you use 50%, partial incontinence.↗
Outcomes and Complications in Hirschsprung Disease
▶Ep 20 · 1:16:55
opinionColitis in Hirschsprung disease is always associated with obstructive symptoms; future research should focus on obstructive etiologies.↗
▶Ep 20 · 1:16:55
opinionColitis in Hirschsprung disease is always associated with obstructive symptoms; future research should focus on obstructive etiologies.↗
Hirschsprung Disease: Surgical Procedures
▶Ep 39 · 42:18
clinicalTo 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.↗
▶Ep 39 · 42:36
clinicalIf you are in the right plane of dissection during endorectal pull-through, the operation is almost bloodless.↗
▶Ep 39 · 42:36
quoteIf you are in the right plane of dissection, this operation is almost bloodless.↗
▶Ep 39 · 42:55
quoteThe 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.↗
▶Ep 39 · 42:55
clinicalWhen you leave a large muscular cuff, the patient will most probably have chronic obstruction, and this chronic obstruction will produce chronic colitis.↗
▶Ep 39 · 44:37
clinicalA posterior myectomy should be performed, resecting 1-2 centimeters in length of the muscular cuff to create a short muscular cuff from below.↗
▶Ep 39 · 51:39
clinicalFull-thickness biopsies should be sent for frozen section, not small seromuscular biopsies, because pathologists suffer when you send very small biopsies for frozen section.↗
▶Ep 39 · 52:57
clinicalOne of the most common problems in endorectal pull-through is leaving a large cuff, which causes obstruction.↗
▶Ep 39 · 53:59
clinicalThe anastomosis should be performed with the most perfect technique possible using fine sutures, 5-0 or 6-0 Vicryl.↗
▶Ep 39 · 58:14
clinicalPatients who improve with rectal irrigation most probably suffer from Hirschsprung disease.↗
▶Ep 39 · 1:00:03
clinicalLong-segment Hirschsprung disease patients do not improve with irrigation—they are totally different and represent another big problem.↗
▶Ep 39 · 1:00:03
quoteLong segments, they don't improve with irrigation. Long segments are, I think is another big problem.↗
▶Ep 39 · 1:00:31
epidemiologicalMore than 80% of Hirschsprung disease patients have rectosigmoid aganglionosis.↗
▶Ep 39 · 1:02:01
clinicalPatients 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.↗
▶Ep 39 · 1:04:05
clinicalThe anal canal is composed of three clear zones: the anoderm with squamous epithelium, the area where the pectinate line lives, and the columnar zone.↗
▶Ep 39 · 1:04:32
clinicalThe columnar zone should be preserved for fecal control.↗
▶Ep 39 · 1:04:32
quoteThe columnar zone should be preserved for fecal control.↗
▶Ep 39 · 1:04:53
clinicalPatients who have had the anal canal removed through different techniques are fecally incontinent, and interestingly, these patients also don't have enterocolitis.↗
▶Ep 39 · 1:06:15
quoteIt's prohibited to do the anastomosis below this line. If you do the anastomosis below this line, the patient will be fecal incontinent.↗
▶Ep 39 · 1:06:27
clinicalIf 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.↗
▶Ep 39 · 1:06:33
quoteIf 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.↗
Hirschsprung Disease: Cases and Complications
▶Ep 41 · 1:16:55
opinionObstructive colitis in Hirschsprung disease exists on a spectrum of severity, and future research should focus on obstructive etiologies to understand this complication.↗
▶Ep 41 · 1:16:55
opinionObstructive colitis in Hirschsprung disease exists on a spectrum of severity, and future research should focus on obstructive etiologies to understand this complication.↗
Outcomes and Complications in Hirschsprung Disease
▶Ep 4 · 1:16:55
opinionColitis in Hirschsprung disease is always associated with obstructive symptoms; future research should focus on obstructive etiologies.↗
Hirschsprung Disease: Cases and Complications
▶Ep 7 · 1:16:55
opinionObstructive colitis in Hirschsprung disease exists on a spectrum of severity, and future research should focus on obstructive etiologies to understand this complication.↗
clinicalThe Swenson technique was originally done in 3 stages: colostomy, then multiple biopsies to determine the exact length of aganglionic area, then pull-through.↗
▶Ep 8 · 32:13
clinicalThe 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.↗
▶Ep 8 · 32:49
clinicalThe Soave technique involved mucosectomy to leave a muscular cuff and pass the colon through the rectum, avoiding any dissection in the pelvis.↗
▶Ep 8 · 33:35
clinicalIn 1980, Philippine surgeons working in the United States published that they achieved primary endorectal pull-through for Hirschsprung patients.↗
▶Ep 8 · 34:05
clinicalHenry Soave said you need to do very good irrigation before starting any surgical procedure for Hirschsprung disease.↗
▶Ep 8 · 34:35
opinionLaparoscopy for Hirschsprung is the same as laparotomy—it's the same Soave, Duhamel, or Swenson technique, just using different instruments.↗
▶Ep 8 · 35:01
opinionIn 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.↗
▶Ep 8 · 35:43
opinionIf 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.↗
▶Ep 8 · 35:43
quoteIf 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.↗
▶Ep 8 · 39:18
quoteIt 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.↗
▶Ep 8 · 41:42
quoteMany surgeons do not recognize the anal canal or they not protect the anal canal during the pull-through.↗
▶Ep 8 · 42:15
clinicalTo 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.↗
▶Ep 8 · 42:36
clinicalIf you are in the right plane of dissection during endorectal pull-through, the operation is almost bloodless.↗
▶Ep 8 · 42:55
clinicalWhen you leave a muscular cuff with a huge, floppy, dilated colon, the patient will most probably have chronic obstruction, which produces chronic colitis.↗
▶Ep 8 · 43:24
clinicalTo create the muscular cuff, place two sutures: one taking mucosa and muscular cuff, the other taking just muscular cuff, then cut in between.↗
▶Ep 8 · 43:51
clinicalAfter 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.↗
▶Ep 8 · 44:30
clinicalWhile 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.↗
▶Ep 8 · 51:39
clinicalFor 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.↗
▶Ep 8 · 52:57
clinicalOne of the most common problems in endorectal pull-through is leaving a large muscular cuff, which causes obstruction.↗
▶Ep 8 · 53:50
clinicalThe anastomosis should be performed with the most perfect technique possible, using fine sutures (5-0 or 6-0 Vicryl).↗
▶Ep 8 · 54:14
clinicalTo perform the anastomosis, remove the Lone Star retractor hooks so you can see the anal canal again and ensure proper placement.↗
▶Ep 8 · 55:35
clinicalWhen doing rectal irrigation for Hirschsprung, if the patient improves immediately, they are a candidate for transanal approach.↗
▶Ep 8 · 1:00:03
clinicalPatients with long-segment or total colonic aganglionosis do not improve with rectal irrigation.↗
▶Ep 8 · 1:01:34
clinicalPatients with late presentation and chronic dilation of the colon (massive megacolon) are not suitable for primary transanal pull-through.↗
▶Ep 8 · 1:02:18
clinicalChronic dilation of the colon has poor motility, so these segments need to be resected.↗
▶Ep 8 · 1:02:47
clinicalTo 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).↗
▶Ep 8 · 1:04:05
clinicalThe anal canal is composed of three zones: anoderm (squamous epithelium), the area where the pectinate line lives, and the columnar zone.↗
▶Ep 8 · 1:04:32
clinicalThe columnar zone should be preserved for fecal control.↗
▶Ep 8 · 1:04:53
clinicalPatients who have had different Hirschsprung techniques (transanal, laparoscopic, Soave, Swenson) and have none of these anal canal elements are fecally incontinent.↗
▶Ep 8 · 1:05:10
clinicalPatients with destroyed anal canals from Hirschsprung surgery do not have enterocolitis but are fecally incontinent.↗
▶Ep 8 · 1:06:09
quoteIt's prohibited to do the anastomosis below this line. If you do the anastomosis below this line, the patient will be fecal incontinent.↗
▶Ep 8 · 1:06:09
clinicalIt is prohibited to do the anastomosis below the columnar zone—if you do, the patient will be fecally incontinent.↗
▶Ep 8 · 1:06:30
clinicalIf you use all of the anal canal shadow area for anastomosis, the patient will have full fecal incontinence; if you use 50%, partial incontinence.↗
Hirschsprung Disease: Surgical Procedures
▶Ep 19 · 42:18
clinicalTo 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.↗
▶Ep 19 · 42:36
quoteIf you are in the right plane of dissection, this operation is almost bloodless.↗
▶Ep 19 · 42:36
clinicalIf you are in the right plane of dissection during endorectal pull-through, the operation is almost bloodless.↗
▶Ep 19 · 42:55
quoteThe 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.↗
▶Ep 19 · 42:55
clinicalWhen you leave a large muscular cuff, the patient will most probably have chronic obstruction, and this chronic obstruction will produce chronic colitis.↗
▶Ep 19 · 44:37
clinicalA posterior myectomy should be performed, resecting 1-2 centimeters in length of the muscular cuff to create a short muscular cuff from below.↗
▶Ep 19 · 51:39
clinicalFull-thickness biopsies should be sent for frozen section, not small seromuscular biopsies, because pathologists suffer when you send very small biopsies for frozen section.↗
▶Ep 19 · 52:57
clinicalOne of the most common problems in endorectal pull-through is leaving a large cuff, which causes obstruction.↗
▶Ep 19 · 53:59
clinicalThe anastomosis should be performed with the most perfect technique possible using fine sutures, 5-0 or 6-0 Vicryl.↗
▶Ep 19 · 58:14
clinicalPatients who improve with rectal irrigation most probably suffer from Hirschsprung disease.↗
▶Ep 19 · 1:00:03
clinicalLong-segment Hirschsprung disease patients do not improve with irrigation—they are totally different and represent another big problem.↗
▶Ep 19 · 1:00:03
quoteLong segments, they don't improve with irrigation. Long segments are, I think is another big problem.↗
▶Ep 19 · 1:00:31
epidemiologicalMore than 80% of Hirschsprung disease patients have rectosigmoid aganglionosis.↗
▶Ep 19 · 1:02:01
clinicalPatients 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.↗
▶Ep 19 · 1:04:05
clinicalThe anal canal is composed of three clear zones: the anoderm with squamous epithelium, the area where the pectinate line lives, and the columnar zone.↗
▶Ep 19 · 1:04:32
quoteThe columnar zone should be preserved for fecal control.↗
▶Ep 19 · 1:04:32
clinicalThe columnar zone should be preserved for fecal control.↗
▶Ep 19 · 1:04:53
clinicalPatients who have had the anal canal removed through different techniques are fecally incontinent, and interestingly, these patients also don't have enterocolitis.↗
▶Ep 19 · 1:06:15
quoteIt's prohibited to do the anastomosis below this line. If you do the anastomosis below this line, the patient will be fecal incontinent.↗
▶Ep 19 · 1:06:27
clinicalIf 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.↗
▶Ep 19 · 1:06:33
quoteIf 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.↗
host_summaryThe Swenson technique was originally done in 3 stages: colostomy, then multiple biopsies to determine the exact length of aganglionic area, then pull-through.↗
▶Ep 2 · 32:13
host_summaryThe 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.↗
▶Ep 2 · 32:49
host_summaryThe Soave technique involved mucosectomy to leave a muscular cuff and pass the colon through the rectum, avoiding any dissection in the pelvis.↗
▶Ep 2 · 33:35
host_summaryIn 1980, Philippine surgeons working in the United States published that they achieved primary endorectal pull-through for Hirschsprung patients.↗
▶Ep 2 · 34:05
host_summaryHenry Soave said you need to do very good irrigation before starting any surgical procedure for Hirschsprung disease.↗
▶Ep 2 · 34:35
opinionLaparoscopy for Hirschsprung is the same as laparotomy—it's the same Soave, Duhamel, or Swenson technique, just using different instruments.↗
▶Ep 2 · 35:01
opinionIn 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.↗
▶Ep 2 · 35:43
opinionIf 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.↗
▶Ep 2 · 35:43
quoteIf 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.↗
▶Ep 2 · 39:18
quoteIt 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.↗
▶Ep 2 · 41:42
quoteMany surgeons do not recognize the anal canal or they not protect the anal canal during the pull-through.↗
▶Ep 2 · 42:15
clinicalTo 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.↗
▶Ep 2 · 42:36
clinicalIf you are in the right plane of dissection during endorectal pull-through, the operation is almost bloodless.↗
▶Ep 2 · 42:55
clinicalWhen you leave a muscular cuff with a huge, floppy, dilated colon, the patient will most probably have chronic obstruction, which produces chronic colitis.↗
▶Ep 2 · 43:24
clinicalTo create the muscular cuff, place two sutures: one taking mucosa and muscular cuff, the other taking just muscular cuff, then cut in between.↗
▶Ep 2 · 43:51
clinicalAfter 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.↗
▶Ep 2 · 44:30
clinicalWhile 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.↗
▶Ep 2 · 51:39
clinicalFor 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.↗
▶Ep 2 · 52:57
clinicalOne of the most common problems in endorectal pull-through is leaving a large muscular cuff, which causes obstruction.↗
▶Ep 2 · 53:50
clinicalThe anastomosis should be performed with the most perfect technique possible, using fine sutures (5-0 or 6-0 Vicryl).↗
▶Ep 2 · 54:14
clinicalTo perform the anastomosis, remove the Lone Star retractor hooks so you can see the anal canal again and ensure proper placement.↗
▶Ep 2 · 55:35
clinicalWhen doing rectal irrigation for Hirschsprung, if the patient improves immediately, they are a candidate for transanal approach.↗
▶Ep 2 · 1:00:03
clinicalPatients with long-segment or total colonic aganglionosis do not improve with rectal irrigation.↗
▶Ep 2 · 1:01:34
clinicalPatients with late presentation and chronic dilation of the colon (massive megacolon) are not suitable for primary transanal pull-through.↗
▶Ep 2 · 1:02:18
clinicalChronic dilation of the colon has poor motility, so these segments need to be resected.↗
▶Ep 2 · 1:02:47
clinicalTo 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).↗
▶Ep 2 · 1:04:05
clinicalThe anal canal is composed of three zones: anoderm (squamous epithelium), the area where the pectinate line lives, and the columnar zone.↗
▶Ep 2 · 1:04:32
clinicalThe columnar zone should be preserved for fecal control.↗
▶Ep 2 · 1:04:53
clinicalPatients who have had different Hirschsprung techniques (transanal, laparoscopic, Soave, Swenson) and have none of these anal canal elements are fecally incontinent.↗
▶Ep 2 · 1:05:10
clinicalPatients with destroyed anal canals from Hirschsprung surgery do not have enterocolitis but are fecally incontinent.↗
▶Ep 2 · 1:06:09
quoteIt's prohibited to do the anastomosis below this line. If you do the anastomosis below this line, the patient will be fecal incontinent.↗
▶Ep 2 · 1:06:09
clinicalIt is prohibited to do the anastomosis below the columnar zone—if you do, the patient will be fecally incontinent.↗
▶Ep 2 · 1:06:30
clinicalIf you use all of the anal canal shadow area for anastomosis, the patient will have full fecal incontinence; if you use 50%, partial incontinence.↗
Hirschsprung Disease: Surgical Procedures
▶Ep 3 · 42:18
clinicalTo 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.↗
▶Ep 3 · 42:36
quoteIf you are in the right plane of dissection, this operation is almost bloodless.↗
▶Ep 3 · 42:36
clinicalIf you are in the right plane of dissection during endorectal pull-through, the operation is almost bloodless.↗
▶Ep 3 · 42:55
clinicalWhen you leave a large muscular cuff, the patient will most probably have chronic obstruction, and this chronic obstruction will produce chronic colitis.↗
▶Ep 3 · 42:55
quoteThe 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.↗
▶Ep 3 · 44:37
clinicalA posterior myectomy should be performed, resecting 1-2 centimeters in length of the muscular cuff to create a short muscular cuff from below.↗
▶Ep 3 · 51:39
clinicalFull-thickness biopsies should be sent for frozen section, not small seromuscular biopsies, because pathologists suffer when you send very small biopsies for frozen section.↗
▶Ep 3 · 52:57
clinicalOne of the most common problems in endorectal pull-through is leaving a large cuff, which causes obstruction.↗
▶Ep 3 · 53:59
clinicalThe anastomosis should be performed with the most perfect technique possible using fine sutures, 5-0 or 6-0 Vicryl.↗
▶Ep 3 · 58:14
clinicalPatients who improve with rectal irrigation most probably suffer from Hirschsprung disease.↗
▶Ep 3 · 1:00:03
quoteLong segments, they don't improve with irrigation. Long segments are, I think is another big problem.↗
▶Ep 3 · 1:00:03
clinicalLong-segment Hirschsprung disease patients do not improve with irrigation—they are totally different and represent another big problem.↗
▶Ep 3 · 1:00:31
epidemiologicalMore than 80% of Hirschsprung disease patients have rectosigmoid aganglionosis.↗
▶Ep 3 · 1:02:01
clinicalPatients 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.↗
▶Ep 3 · 1:04:05
clinicalThe anal canal is composed of three clear zones: the anoderm with squamous epithelium, the area where the pectinate line lives, and the columnar zone.↗
▶Ep 3 · 1:04:32
clinicalThe columnar zone should be preserved for fecal control.↗
▶Ep 3 · 1:04:32
quoteThe columnar zone should be preserved for fecal control.↗
▶Ep 3 · 1:04:53
clinicalPatients who have had the anal canal removed through different techniques are fecally incontinent, and interestingly, these patients also don't have enterocolitis.↗
▶Ep 3 · 1:06:15
quoteIt's prohibited to do the anastomosis below this line. If you do the anastomosis below this line, the patient will be fecal incontinent.↗
▶Ep 3 · 1:06:27
clinicalIf 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.↗
▶Ep 3 · 1:06:33
quoteIf 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.↗
