Laparoscopic-assisted transanal Soave pull-through procedure for Hirschsprung's disease and allied disorders / 中华普通外科杂志

ABSTRACT

ObjectiveTo explore the feasibility and outcomes of natural orifice transanal laparoscopic Soave procedure for Hirschsprung's disease and allied disorders (HAD).MethodsFrom March 2010 to December 2011,31 cases (at the age from 3 mos to 6 yrs) with Hirschsprung's disease or allied disorders (5 cases)underwent laparoscopic-assisted Soave pull-through procedure at two tertiary hospitals.We modified this technique by mobilizing the left hemicolon or whole colon via rectal muscular sleeve approach under transanal or transumbilical laparoscopic vision,then endorectal pull-through to completearectosigmoidectomyorsubtotalcolectomy. ResultsAllprocedureswerecompleted successfully.A rectosigmoidectomy was performed in 16 cases with classic HD and subtotal colectomy in 15 cases with extended HD and HAD.The average operative time was ( 117 ± 13) min.The length of the resected segment was 35 -80 cm,and the estimated blood loss was 5 -20 ml. One infant developed postoperative intestinal obstruction that required open exploration.Follow-up of one to 20 mos found no stoma stenosis or constipation recurrence. Enterocolitis developed in 1patient.ConclusionsTransanal or transumbilical laparoscopic-assisted Soave pull-through surgery is safe,effective and with a benefit of much less invasion and almost invisible scars.