J Korean Assoc Pediatr Surg.  2013 Dec;19(2):130-139. 10.13029/jkaps.2013.19.2.130.

Primary Laparoscopic-Assisted Endorectal Pull-Through for Hirschsprung's Disease

• Park BS
• Sul JY

• KMID: 1961503
• DOI: http://doi.org/10.13029/jkaps.2013.19.2.130

Abstract

The application of laparoscopic techniques for the surgical management of Hirschsprung's disease is the recent trend. We described the surgical technique and postoperative long-term outcomes of the one-stage, laparoscopic-assiseted endorectal pull-through operation for Hirschsprung's disease. The technique uses three to four small abdominal ports. Laparoscopic mobilization of the sigmoid colon and rectum is performed and marginal artery-preserving colon pedicle is prepared. The rectal mobilization is performed using a transanal endorectal sleeve technique. The anastomosis is performed 0.5~1 cm above the dentate line. The age at surgery ranged from 6 days to 4 years. The average operative time was 144 minutes. Almost all of the patients passed stool and flatus within 36 hours of surgery. The average hospital stay after surgery was 6.5 days. Among 42 patients, 32 patients older than 3 years old were evaluated for function on defecation. All 32 patients have been continent, of those who needed laxatives were 11 (34.3%) due to constipation and overflow incontinence. Four children (12.5%) have remained dependent on laxatives. Laparoscopic-assisted endorectal pull-through operation for Hirschsprung's disease appears to be safe, provides the less pain, shorter time to full feeding, shorter hospital stay, and excellent cosmetic outcomes. Helping patients and parents ensure the quality of life, they should be provided with counseling, education, and longer-term follow-up care.

Keyword

Hirschsprung's disease; One-stage; Laparoscopic-assisted endorectal pull-through; LAERPT

MeSH Terms

Child
Colon
Colon, Sigmoid
Constipation
Counseling
Defecation
Education
Flatulence
Follow-Up Studies
Hirschsprung Disease*
Humans
Laxatives
Length of Stay
Operative Time
Parents
Quality of Life
Rectum
Laxatives

Reference

1. Teitelbaum DH. Hirschsprung's disease. In : O'Neill JA, Grosfeld JL, Fonkalsrud EW, Coran AG, Caldamone AA, editors. Principles of Pediatric Surgery. ed 2. St. Louis: Mosby;2004. p. 573–586.

2. Gunnarsdóttir A, Wester T. Modern Treatment of Hirschsprung's disease. Scand J Surg. 2011; 100:243–249.

3. Swenson O. Hirschsprung's disease-a complicated therapeutic problem: some thoughts and solutions based on data and personal experience over 56 years. J Pediatr Surg. 2004; 39:1449–1453.

4. Chatoorgoon K, Pena A, Lawal TA, Levitt M. The Problematic Duhamel Pouch in Hirschsprung's disease: manifestations and treatment. Eur J Pediatr Surg. 2011; 21:366–369.

5. Soave F. A new surgical technique for the treatment of Hirschsprung's disease. Surgery. 1964; 56:1007–1044.

6. Haricharan RN, Georgeson KE. Hirschsprug disease. Semin Pediatr Surg. 2008; 17:266–275.

7. Doughty D, Junkin J, Kurz P, Selekof J, Gray M, Fader M, Bliss DZ, Beeckman D, Logan S. Incontinence-Associated Dermatitis Consensus Statement, Evidence-Based Guidelines for Prevention and Treatment, and Current Challenges. J Wound Ostomy Continence Nurs. 2012; 39:303–315.

8. Dasgupta R, Langer JC. Transanal pull-through for Hirschsprung disease. Semin Pediatr Surg. 2005; 14:64–71.

9. Dasgupta R, Langer JC. Hirschsprung disease. Curr Probl Surg. 2004; 41:942–988.

10. van de Ven TJ, Sloots CE, Wijnen MH, Rassouli R, van Rooij I, Wijnen RM, de Blaauwl I. Transanal endorectal pull-through for classic segment Hirschsprung's disease: With or without laparoscopic mobilization of the rectosigmoid. J Ped Surg. 2013; 48:1914–1918.

11. Hollwarth ME, Rivosecchi M, Schleef J, Deluggi S, Fasching G, Ceriati E, Ciprandi G, DePeppo F. The role of transanal endorectal pull-through in the treatment of Hirschsprung's disease- A multicenter experience. Pediatr Surg Int. 2002; 18:344–348.

12. Georgeson KE, Robertson DJ. Laparoscopic-assisted approaches for the definitive surgery for Hirschsprung's disease. Semin Pediatr Surg. 2004; 12:256–262.

13. Craigie RJ, Conway SJ, Cooper L, Turnock RR, Lamont GS, Baillie CT, Kenny SE. Primary pull-through for Hirschsprung's disease: Comparison of open and laparoscopic-assisted procedures. J Laparoendosc Adv Surg Tech A. 2007; 17:809–812.

14. Hassan HS, Hashish AA, Fayad H, Elian A, Elatar A, Afify M, Elhalaby EA. Redo Surgery for Hirschsprung's disease. Ann Pediatr Surg. 2008; 4:42–50.

15. Nasr A, Langer JC. Evolution of the technique in the transanal pull-through for Hirschsprung's disease: effect on outcome. J Pediatr Surg. 2007; 42:36–39.

16. Tang ST, Wang GB, Cao GQ, Wang Y, Mao YZ, Li SW, Li S, Yang Y, Yang J, Yang I. 10 years of experience with laparoscopic-assisted endorectal Soave pull-through procedure for Hirschsprung's disease in China. J Laparoendosc Adv Surg Tech A. 2012; 22:280–284.