Does high-pressure carbon dioxide insufflation facilitate mucosal dissection in transanal endorectal pull-through? A rabbit model.

The aim of the present study was to investigate whether high-pressure carbon dioxide insufflation facilitates mucosal dissection in the transanal endorectal pull-through (TEPT) operation performed in Hirschsprung's disease in a rabbit model. In the study, ten New Zealand rabbits were used. In six of the rabbits, CO(2) under 50 mmHg pressure was insufflated into the submucosal area through a 25-gauge scalp needle inserted 0.3 cm over the dentate line. Two of the rabbits were taken for histopathological examination. In four rabbits, the TEPT operation was performed and in another four the operation was performed without CO(2) insufflation. Histopathological examination in the CO(2)-insufflated group of rabbits showed that at transversal incisions mucosa was seen to be separated circumferentially from submucosa by high pressure CO(2) and at longitudinal incision the separation was seen to be complete along the anal canal. It was noted that mucosal dissection was rapid, non-bloody and without induced mucosal tears or perforation; however, in the non-insufflated group the operation was time-consuming, bloody and more difficult to perform and needed meticulous care. In the present study, it was seen that submucosal high pressure CO(2) insufflation in rabbits facilitates mucosal dissection in the TEPT operation and is easy to perform, time-saving and highly economical.