Laparoscopic-assisted Partial or Subtotal Colectomy and Per Anum Intrarectal Pull-through Procedures for Hirschsprung's Disease-Allied Disorder in Children / 中国微创外科杂志

ABSTRACT

Objective To explore the feasibility of laparoscopic-assisted partial and subtotal colectomy and per anum intrarectal pull-through procedures for Hirschsprung's disease-allied disorder(HAD).Methods From October 1999 to May 2006,38 infants and children with HAD or Hirschsprung's disease(HD) associated with HAD,to whom conservative treatments proved ineffective or relapse occurred,were treated by laparoscopic-assisted partial or subtotal colectomy and per anum intrarectal pull-through procedures.Four 5 mm trocars were inserted at the edge of umbilicus,right upper,right lower and left center quadarant of abdomen when subtotal colectomy was carried out.Two trocars were placed in the left side,lied in left upper and mid lower quadarant of abdomen respectively.Colon descendens,colon transversum,colon ascendens and ileocecal junction lateral peritoneum were mobilized under laparoscope.The operation on anus was referred to modified Soave procedures.Results 38 patients underwent the operations successfully.Left hemicolon resection were performed in 9 cases,with operation time being 110-180 min(mean,135 min).Subtotal colectomy were performed in 29 cases and colon ascendens were rotated reversal clockwise 270? and pulled down using Deloyers procedures,lengths of remaining colon ascendens being 7-13 cm(mean,11.5 cm),operation time being 140-220 min(mean,175 min),intraoperative blood loss being 15-70 ml(mean,35 ml).Postoperative pathological diagnosis showed 10 cases of intestine neuron developmental anormaly(IND),3 cases of hypoganglionosis(HG),4 cases of immature gangliocyte(IGC),9 cases were not classified,6 cases of HD complicated with IND,2 cases of HD complicated with HG,4 cases of HD complicated with ICG.38 cases were followed up for a mean of 3 years and 5 months(range,6 months to 7 years).9 cases of left hemicolon resection had 1-2 stools per day at 6 months postoperatively without stoma stenosis and constipation recurrence.Conclusions Laparoscopic-assisted partial or subtotal colectomy and radical per anum pull-through procedures for HAD are safe,effect,feasible,with minimal invasion,but some laparoscopic procedure experiences are required.