Rectosigmoidectomy with ileal loop interposition: a new surgical method for the treatment of chagasic megacolon.

Purpose: Chagasic megacolon occurs frequently in central Brazil. There are several surgical techniques for the treatment of megacolon and no consensus on which one is the best. Our goal is to present a new surgical treatment for chagasic megacolon.

Methods: One hundred forty-seven patients with chagasic megacolon were submitted to surgical treatment between January 1985 and December 1995. Fourteen patients were lost to follow-up because they could not be reached. Patients were evaluated preoperatively and submitted to rectosigmoidectomy with interposition of an isoperistaltic segment of ileum between the descending colon and the rectum.

Results: There were three deaths in the postoperative period, two because of complications caused by septic peritonitis and one because of hypovolemic shock. Major complications occurred in 5.4 percent of the cases: four dehiscences at the ileocolic anastomosis and two at the ileorectal anastomosis. Minor complications corresponding to 3.1 percent of the total included two with abdominal wall infection, one with a temporary infection, and one with a cardiac arrhythmia. Four patients (3.1 percent) had recurrence of constipation.

Conclusion: Rectosigmoidectomy with interposition of an ileal segment is a new therapeutic option for chagasic megacolon that has several advantages in relation to the other techniques because of its ease of execution, lack of complications such as those seen in pull-through procedures, and a low recurrence rate.