Surgical treatment of Chagas megacolon. Critical analysis of outcome in operative methods

Acta Cirurgica Brasileira

Ricardo Luiz Santos Garcia²  Bruna Meyer R. De Matos¹  Omar Féres²  José Joaquim Ribeiro Da Rocha² 

[1] ,University of São Paulo Ribeirão Preto Faculty of Medicine Department of Surgery and Anatomy,Brazil

关键词: Chagasic Megacolon;    Chagas Disease;    Surgical Treatment;    Megacólon Chagásico;    Doença de Chagas;    Tratamento Cirúrgico;   

DOI  :  10.1590/S0102-86502008000700015

来源: SciELO

【 摘 要 】

PURPOSE: Surgical treatment of chagasic megacolon has suffered innumerable transformations over the years. Poor knowledge of the disease physiopathology is one of the reasons. METHODS: From January 1977 to December 2003, 430 patients were submitted to surgical treatment for chagasic megacolon. Of these procedures, 351 were elective and 79 emergency operations carried out at the University Hospital of Ribeirão Preto. Four elective operations, most frequently used, should be singled out: anterior rectosigmoidectomy (52.71%), left hemicolectomy (18.23%), Duhamel-Haddad operation(15.95%), and total colectomy (5.98%). From the 79 exploratory laparotomies performed on an emergency basis, 53 (67.09%) required intestinal resection. From the 430 patients operated upon, 268 (62.33%) progressed without recurrence of intestinal constipation, and 71 (15.51%) had a recurrence. RESULTS AND DISCUSSION: Based on the data collected, left hemicolectomy had the highest constipation recurrence rate compared to other operating procedures; anterior retosigmoidectomy had less complication episodes and a larger recurrence of intestinal constipation in comparison to the Duhamel-Haddad operation. Emergency operations, mainly for the treatment of volvulus and fecaloma, presented high morbidity and mortality and required extensive intestinal resections, stomas and reoperations.

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