Surgical anatomy of the pelvis as a basis for pull-through procedures in Hirschsprung's disease

Background: The basis for successful pull-through procedures in patients with Hirschsprung's disease is a detailed knowledge of the anatomy of the pelvis. The currently most utilized pull-through techniques were reviewed with regard to their impact on the anatomy of different regions of the pelvis. The findings were analyzed as to advantages and disadvantages of the respective procedures. Methods: The anatomy of the pelvis was studied in three children by post mortem examination. The study was approved by the institutional ethics committee. Results: The study confirmed five anatomical regions of the pelvis of surgical importance which should be considered when planning and performing a pull-through procedure. It could be shown that the fascial coating of the rectum plays an important role in an adequate pull-through procedure. Conclusions: The type of complications that may be expected and the prognosis of a pull-through procedure is influenced by the given anatomical conditions of the pelvis. Thus, an adequate procedure should respect the anatomical characteristics of the five surgically important anatomical regions of the pelvis.