A new modified Swenson transanal pull －through procedure with laparoscope －assisted in Hirschsprung＇s allied disease / 中华实用儿科临床杂志

ABSTRACT

Objective To introduce the laparoscope_assisted modified Swenson transanal pull_through pro_cedure and analyze its clinical outcome for Hirschsprungˊs allied disease(HAD). Methods Thirty_six patients with HAD underwent this new procedure at the Pirst Affiliated Hospital of Harbin Medical University during October 2009 to March 2016. During laparoscope exam,biopsies were taken from rectum,sigmoid and descending colon for rapid frozen pathological biopsy slices. Then the affected colons were dissected to the left hemicolon. Subsequently,a sponge forcep was inserted into anus and the colon was pulled through the right below the peritoneal reflection. In order to prevent re_traction and mark the resection line,sutures were performed circumferentially both at the proximal and distal bowel wall. Between the circles,a full_thickness,circumferential incision of rectum was made. The proximal bowel was mobi_lized out through the anus to the laparoscope part. The distal end was dissected anteriorly 2. 5_3. 0 cm above the den_tate line. The posterior rectal wall was split medium longitudinally and dissected to 0_0. 5 cm above the dentate line, so as to make a full _thickness ＂V＂ _shaped anastomosis. Results Dostoperative anal function scores33 cases (91. 7%)were excellent,3 cases(8. 3%)were good,and no grades were scored. Compared with preoperative,the anal canal rest pressure[(12. 93 ± 3. 17)kDa,(11. 19 ± 6. 50)kDa vs.(22. 03 ± 6. 23)kDa],length of anal canal high pressure area[(25. 46 ± 5. 56)mm,(21. 61 ± 5. 10)mm vs.(35. 26 ± 5. 05)mm],and rectal resting pressure [(0. 79 ± 0. 29)kDa,(0. 64 ± 0. 23)kDa vs.(1. 22 ± 1. 02)kDa]decreased significantly after 6 month∕1 year follow_up,and the differences were significant(all P〈0. 05). The length of anal canal high pressure area was different be_tween 6 months and 1 year follow_up(P〈0. 05). However,the static pressure of the anal canal and the rectum did not differ significantly(all P〉0. 05). All the patients were diagnosed as HAD on the basis of intraoperative frozen lice ex_amination and postoperative pathologic examination. Thirty_six patients were followed up,and the reported complica_tions included soiling in 1 case(2. 8%),enterocolitis in 2 cases(5. 6%),without complications. During mean follow_up time(3. 3 years),none of the patients relapsed. Conclusions Laparoscope_assisted modified Swenson procedure for HAD is a minimally invasive approach with satisfactory results.