Transanal one-stage endorectal technique for Hirschprung's disease--a preliminary report of 24 cases from a single institution.

Numerous surgical techniques for Hirschprung's disease have been developed and modified, being associated with extensive surgical procedures involving laparotomy, resection of affected segment of colon and descensus of the functional bowel to the anus. Conventional surgery was followed by complications, although the incidence of early and late postoperative complications has significantly decreased. Transanal mucosectomy was practiced as a part of conventional and laparoscopic assisted pull through procedures. The latest promising achievement is entirely transanal pull-through procedure, described by De la Tore-Mondragon and Ortega-Salgado: entirely transanal endorectal pull-through, thus avoiding both laparotomy and laparoscopy. Due to minimal invasive surgery it offers excellent results. During a five year period (2003-2008), 24 patients were operated with this technique. The recovery was uneventful in all patients. This study adds valuable information of meticulous details of the new, still developing technique with the emphasis on controversies about surgical complications reported in multicentric studies.

Side-to-end hypoglossal-facial anastomosis via transposition of the intratemporal facial nerve.

The technique of facial nerve repair with side-to-end hypoglossal-facial anastomosis is presented and evaluated in five patients who were operated on for facial nerve paralysis after acoustic schwannoma surgery, or had cranial base trauma. The end-to-end hypoglossal-facial anastomosis is accompanied by hemilingual paralysis, with difficulty in swallowing, chewing and speaking. In this new technique, the facial nerve is mobilised in the temporal bone, transected at the second genu and transposed to the hypoglossal nerve where a tensionless side-to-end anastomosis is performed. The hypoglossal nerve is transected in oblique fashion to about one third of its circumference. We were able to achieve a tensionless anastomosis in all patients. The idea is to bring about re-innervation of the previously denervated tissue via a collateral sprouting of axons of the donor nerve through the site of coaptation without sacrificing the innervation of the donor nerve's original targets. With side-to-end hypoglossal-facial anastomosis, two patients attained a House- Brackmann grade of III (one of them with independent movement of eyelids and mouth); one achieved grade IV, another grade V and grade VI. No patient had hemilingual atrophy nor any problems associated with swallowing or chewing.