Tricks - New Duhamel - Laparoscopic Trans-rectal Rectosigmoidectomy

The new Duhamel pull-through was designed to eliminate the septic intraabdominal step, avoid intraabdominal sutures, determine the length of the residual stump, and assure a more secure colorectal anastomosis.

The posterior rectal wall incision is made 1.5 centimeters from the dentate line.

The retrorectal tissue is easily dissected digitally, allowing access to the retrorectal space to the sacral promontory.

Dissection is performed along the lateral walls of the rectum approximately 50% of the circumference of the posterior rectal wall.

The laparoscopic endopelvic dissection and entry into the retrorectal space is described as basically a bloodless process.

The sigmoid is stapled transversely with a GIA stapler 75 millimeters, which can be reinforced with PDS or Vicryl invaginating sutures.

The level at which to cut is defined by pathologic markers intraoperatively by frozen section or by mapping a transition zone with previous suction biopsies.

The anastomosis is completed with the Martin technique and modification, leaving a very ample window with minimal chance of stenosis.

At 6 months postoperatively, colonoscopy showed a residual pouch of approximately 3 centimeters in an asymptomatic patient.

Problems that can occur include accumulation of feces, constipation, and fecal impaction when the stump is left too long.

The residual stump can be divided if necessary, as demonstrated via video.

The technique is recommended for all pediatric patients, including patients with very dilated colons, and is described as reproducible, easy, and fast with minimal incidence of constipation and stenosis.