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Total laparoscopic modified Duhamel operation in combination with transanal endoscopic microsurgery
Yi Han1, Mou-Bin Lin1, Ya-Jie Zhang1
1Department of General Surgery, RuiJin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
Summary
This study presents a novel surgical approach for megacolon, combining total laparoscopic surgery with transanal endoscopic microsurgery. This technique minimizes abdominal incisions, reducing patient pain and recovery time.
Area of Science:
- Colorectal Surgery
- Minimally Invasive Surgery
- Pediatric Surgery
Background:
- Traditional laparoscopic-assisted colonic resection often necessitates an abdominal incision for specimen retrieval, contributing significantly to postoperative pain.
- The modified Duhamel operation is a standard procedure for megacolon, but specimen extraction typically requires an additional abdominal incision.
Observation:
- Two cases of megacolon (Hirschsprung disease in a 15-year-old and adult megacolon in a 60-year-old) were treated using a total laparoscopic modified Duhamel operation.
- Transanal endoscopic microsurgery was employed for transanal specimen retrieval and anastomosis, completely avoiding an abdominal extraction incision.
- Both patients experienced minimal postoperative pain, required limited narcotic use, and had no surgical complications.
Findings:
- The combined total laparoscopic modified Duhamel operation and transanal endoscopic microsurgery successfully treated both pediatric and adult megacolon cases.
- This technique eliminated the need for an abdominal extraction incision, a common source of pain in laparoscopic colectomies.
- Patients demonstrated excellent recovery, with discharge on postoperative days 9 and 13.
Implications:
- This combined surgical approach represents a feasible and minimally invasive option for managing various forms of megacolon.
- Integrating laparoscopy with natural orifice transluminal endoscopic surgery principles offers a less painful and potentially faster recovery for patients.
- This technique holds promise for advancing surgical management of complex colorectal conditions, particularly in pediatric and adult megacolon cases.
