Colonic Derotation Revisited: The "Deloyers Procedure" for Long-Segment Hirschsprung Disease

Long-segment Hirschsprung disease (HSCR) presents significant challenges in surgical management, often requiring extensive bowel mobilization and creative techniques to achieve tension-free anastomosis. Colonic derotation offers a viable solution for preserving bowel length and maintaining the ileocecal valve, which is crucial for postoperative bowel function. The procedure involves extensive colonic mobilization and strategic vascular divisions of the right and middle colic vessels while preserving the ileocolic and marginal arteries, followed by a 180° counterclockwise rotation of the colon around the ileocolic vascular axis. Critical aspects include ensuring proper bowel orientation post-derotation, the careful assessment of potential compression points, and the preservation of the appendix for potential future antegrade enema conduit creation. The procedure concludes with a transanal pull-through and coloanal anastomosis, achieving optimal bowel positioning without undue tension or laxity. This technique provides a valuable option in the surgical armamentarium for managing complex cases of long-segment Hirschsprung disease.