Paediatric surgery: Hirschsprung pull-through procedures: practice question

A General Surgery question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Surgery · Paediatric surgery: Hirschsprung pull-through procedures

Sample item

An infant with biopsy-proven Hirschsprung disease has a pull-through in which the aganglionic rectal stump is left in place behind the ganglionic colon, and the two are joined side-to-side with a stapler. Which procedure is this?

ADuhamelBRehbeinCSoaveDSwenson

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

A. Duhamel

In the Duhamel operation the ganglionic colon is brought down behind the retained aganglionic rectum and a side-to-side anastomosis is made. Swenson removes the aganglionic rectum with an oblique coloanal anastomosis, Soave performs an endorectal mucosectomy and pull-through within the muscular cuff, and Rehbein is a low anterior resection with end-to-end anastomosis.

Option by option

A. Duhamel (correct)
Correct. Retaining the rectal stump with a side-to-side anastomosis defines Duhamel.
B. Rehbein
Rehbein resects the aganglionic segment with an end-to-end anastomosis.
C. Soave
Soave strips the rectal mucosa and pulls the colon through the retained muscular cuff.
D. Swenson
Swenson excises the aganglionic rectum and makes a coloanal anastomosis.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

Questions about this General Surgery question

What is the answer to this General Surgery question?

The best answer is A, Duhamel. In the Duhamel operation the ganglionic colon is brought down behind the retained aganglionic rectum and a side-to-side anastomosis is made.

Why is "Rehbein" not the answer?

Rehbein resects the aganglionic segment with an end-to-end anastomosis.

Why is "Soave" not the answer?

Soave strips the rectal mucosa and pulls the colon through the retained muscular cuff.

Why is "Swenson" not the answer?

Swenson excises the aganglionic rectum and makes a coloanal anastomosis.

What concept does this question test?

It tests Paediatric surgery: Hirschsprung pull-through procedures in General Surgery. Swenson removes the aganglionic rectum with an oblique coloanal anastomosis, Soave performs an endorectal mucosectomy and pull-through within the muscular cuff, and Rehbein is a low anterior resection with end-to-end anastomosis.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Paediatric surgery: Hirschsprung pull-through procedures?

Learn classic signs and eponyms alongside what they diagnose. Then use the flashcards and the other General Surgery questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.