[Chagasic megacolon. Treatment by abdominal recto-sigmoidectomy with mechanical colo-rectal termino-lateral...

Abdominal rectosigmoidectomy with end to side colorectal mechanical anastomosis is proposed as a new technique for surgical treatment of Chagasic megacolon. The rectum is sectioned and closed at the level of the peritoneal reflexion. The end of the descending colon is anastomosed to the posterior surface of the rectum, as distal as possible, using the intraluminal stapler (Ethicon CDH33). The final result of the operation is similar to Duhamel-Haddad technique with the advantage of being a one stage operation. Forty-three patients with chagasic megacolon were operated on during the period 1989-1994. Twenty-seven were female and 16 were male with ages ranging from 23 to 76 and a mean of 46.1 years. Results obtained were satisfactory; there were no deaths; only three postoperative complications occurred (6.9%). Only one of these (dehiscence of the rectal cupula) was specific for the proposed technique. The two others were intestinal obstruction, due to volvulus of the small intestine in one case and to adhesions in the other. All complications were managed by surgery. All patients are being followed regularly and up to the present time they report daily bowel movements, passing well-formed stools. There are no complaints of fecal incontinence sexual function or disturbed formation of fecaloma in the rectal stump. The colorectal anastomosis was ample in all patients. Since this is a one stage operation with a low rate of complications, the short hospital stay largely compensates the cost of the mechanical suturing device. Regarding recurrences, a long follow-up period of at least 10 years is necessary to evaluate the real effectiveness of this technique.