Avaliação clínica, manométrica e profilométrica dos pacientes portadores de megacolo congênito submetidos à cirurgia de abaixamento de colo pelas técnicas de Duhamel modificado ou Retossigmoidectomia Transanal. / Clinical, manometric and prophilometric evaluation of patients with Hirschsprungs Disease underwent to pull-through techniques of modified Duhamel or transanal rectosigmoidectomy.

Elaine Cristina Soares Martins

Objective: Several techniques are being proposed for a definite treatment using surgery for the Hirschsprungs disease or congenital megacolon (CM). This study aims to evaluate the differences in the surgery results obtained with manometric anorectal procedure and profilometric analysis, as well as verify its correlation with clinical parameters of patients fecal standard results who were submitted to one of these two techniques for the CM chirurgic treatment: 1.colectomy of the aganglion segment and modified Duhamel procedure (MD) to perform a pull through of the ganglionic colon; and 2. colectomy of the anglion segment and modified transanal rectosigmoidectomy (MTR). Methods: The present study submitted, for the period of April 2001 to March 2006, 42 patients to clinical evaluations and anorectal manometry for a post-operative control for a CM correction procedure, of which 36 were male (74%) and 6 female (26%). All patients were submitted to the exam without sedation, using the perfusion technique, in the post-operative period, seeking to evaluate the resting pressure (RP), the pressure response of the sphincter to cough (C), the pressure response to voluntary contraction (VC), the pressure response to sustained voluntary contraction (SVC), the pressure response to perianal stimulation (PAS), the analysis of the rectal sphincter reflex (RSR) and to analyze the standard and potentiation pressure curves. With the pressures acquired from the pressure curve elaboration in the perfusion channels, a tridimensional image of the anorectal canal was taken, allowing us to study the distribution of the pressure in the anorectal walls. Furthermore, aiming to compare the manometric, profilometric and clinical variables between the two exploited techniques, a Student-t test was applied for the cases in which the variables were continuous. A Chi-squared test was also proposed and, whenever necessary, the Fishers exact test; in order to verify the differences in the distribution of a categorized characteristic, as well as to compare the variables between the techniques regarding the fecal continence standard (continent and partially continent), and the significant level criteria adopted was 5%. Results: The ARM demonstrated RP average of 53,44 mmHg for the MD group and 60,67 mmHg for the MTR. Regarding the VC pressure, an average of 94,50 mmHg was attained for the MD group and of 95,47 mmHg for the MTR. There is not a significant difference, statistically, between the MD and MTR groups. It is important to highlight that the average amount of the voluntary contraction pressure was almost double the resting pressure, which is expected, in general, when incontinence research is concerned. It was also noticed, that there was no significant difference, statistically, among the manometric variables, independently of the technique employed, whether in the general group, in the continent group, or, even in the partially continent group. The nonexistence of a significant difference, statistically, for the pressure amount of the internal, external sphincter and ascending colon reinforce the idea that the pull through procedure with the oversewing of the rectum technique, similar to the one proposed by Swenson, do not expose the complex of the sphincter muscles to risks.The absence of RSR was observed in almost all of the analyzed cases, which to the forms CPS and CPP did not show significant difference, statistically, independently of the technique employed. There is also no significant difference, statistically, for the CPS and CPP forms to the continent and partially continent groups, whether in the general group, in the DM group or in the MTR group. Conclusion: With this present study, it was perceived that both operative procedures for pull through procedure of the ganglionic colon, in which case were, the MD technique and MTR technique, are equivalent from the manometric and profilometric standpoint.

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