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Hybrid Single-Incision Laparoscopic Approaches for Endorectal Pull-Through in Hirschsprung's Disease
Tajammool Hussein Aubdoollah1, Shao-Tao Tang1, Li Yang1
1Department of Pediatric Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology , Wuhan, China .
Insights
Hybrid single-incision laparoscopic endorectal pull-through (H-SILEP) offers a safe and technically improved approach for Hirschsprung
Area of Science:
- Pediatric Surgery
- Gastrointestinal Surgery
- Minimally Invasive Surgery
Background:
- Transanal endorectal pull-through (TEP) for Hirschsprung's disease (HD) carries risks of sphincter and mesentery overstretching.
- Single-incision laparoscopic endorectal pull-through (SILEP) improves cosmesis but presents surgical challenges like instrument clashing.
- Hybrid SILEP (H-SILEP) was developed to enhance SILEP in selected HD patients.
Purpose of the Study:
- To evaluate the feasibility and safety of a novel hybrid single-incision laparoscopic endorectal pull-through (H-SILEP) technique.
- To assess the technical advantages and patient outcomes of H-SILEP for Hirschsprung's disease.
- To determine if H-SILEP reduces surgical difficulty and improves ergonometrics compared to standard SILEP.
Main Methods:
- A retrospective review of 36 HD patients who underwent H-SILEP between August 2010 and July 2013.
- Data collected included patient demographics, transitional zone, operative time, blood loss, and complications.
- Short- and long-term outcomes, including cosmetic results, were assessed postoperatively.
Main Results:
- H-SILEP was performed without additional ports or conversion to laparotomy in all 36 patients.
- The mean operative time was 116 minutes with no major intraoperative complications.
- Early complications included perianal excoriation (9 patients); no anastomotic leaks or recurrent constipation were observed. Excellent cosmetic results were achieved.
Conclusions:
- H-SILEP is a feasible and safe surgical technique for selected Hirschsprung's disease patients.
- The H-SILEP procedure is technically less challenging and offers improved ergonometric benefits.
- This hybrid approach represents an advancement in minimally invasive surgery for HD.
Background:
Transanal endorectal pull-through for Hirschsprung's disease (HD) is a relatively safe and feasible procedure in neonates and infants. However, overstretching on the anal sphincter and mesentery of the sigmoid colon might cause potential risk of impaired defecation function. Single-incision laparoscopic endorectal pull-through (SILEP) is technically feasible and safe in HD patients, offering a better cosmetic result. However, it is stressful for the surgeon in view of its low manipulability and poor visualization causing clashing of instruments, especially in older children or patients with long-segment aganglionosis. We developed an age- and type-appropriate technique of hybrid SILEP (H-SILEP) using a trocarless instrument via another abdominal stab incision to obtain further improvement of SILEP in selected HD patients.
Patients And Methods:
Between August 2010 and July 2013, 36 patients (24 boys and 12 girls, with a mean age of 3.9 months) with HD underwent H-SILEP. Patient age, gender, transitional zone, operative time, blood loss, and intraoperative and postoperative complications, as well as short- and long-term results, were assessed.
Results:
Ten patients had transitional zone in the rectum, 17 patients in the sigmoid colon, and 9 patients in the descending colon. Neither additional ports nor conversion to laparotomy was required in these 36 patients. The mean operative time was 116 minutes. There was no major intraoperative complication. Perianal excoriation was the main early postoperative complication, which occurred in 9 patients. No anastomotic leak occurred. Postoperative enterocolitis occurred in 2 patients. There was no recurrent constipation. Follow-up for 6 months to 3 years in all patients showed an excellent cosmetic result.
Conclusions:
Our procedure is feasible and safe, and it is technically less challenging to perform H-SILEP in selected HD patients. Moreover, it is better to use additional instruments for ergonometric reasons.
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