Pull-through Operation First Step (Hirschsprung´s Disease)

Pull-through operation, first step. Laparotomy in the left lower abdomen. On the right side the rectum is running from below out of the pelvis and continuing on the left side after a funnel-shaped transitional zone in the sigmoid. The left ureter is being retracted to the side with a yellow string. After opening the abdomen, biopsies have been performed from the wall of the aganglionic segment, the transitional zone, and the normal colon situated further cranially for histological examination using the macroscopic aspect of the intestine as a landmark. During the waiting time a preparation and skeletization of the segment of sigmoid and descendant colon is performed which is provided for a tension-free pull-through. This is one of the most demanding steps of this procedure because the blood supply comes not from the lower mesenteric artery but from the arcades of the blood supply of the middle colonic artery which must be preserved.