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Clinical outcomes and ergonomics analysis of three laparoscopic techniques for Hirschsprung's disease
Tajammool Hussein Aubdoollah1, Kang Li1, Xi Zhang1
1Tajammool Hussein Aubdoollah, Kang Li, Xi Zhang, Shuai Li, Li Yang, Hai-Yan Lei, Ponnie Robertlee Dolo, Xian-Cai Xiang, Guo-Qing Cao, Guo-Bin Wang, Shao-Tao Tang, Department of Pediatric Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, Hubei Province, China.
Insights
This study compared three laparoscopic techniques for Hirschsprung
Area of Science:
- Pediatric Surgery
- Minimally Invasive Surgery
- Surgical Outcomes
Background:
- Hirschsprung's disease (HD) management often involves laparoscopic endorectal pull-through procedures.
- Various laparoscopic approaches exist, each with potential benefits and drawbacks.
- Optimizing surgical technique is crucial for patient outcomes and surgeon ergonomics.
Purpose of the Study:
- To evaluate and compare the clinical outcomes and ergonomic efficiency of three laparoscopic approaches for Hirschsprung's disease.
- To analyze conventional laparoscopic pull-through (CLP), single-incision laparoscopic pull-through (SILP), and hybrid single-incision laparoscopic pull-through (H-SILP).
- To provide insights for selecting the optimal laparoscopic approach based on patient factors and desired results.
Main Methods:
- Retrospective analysis of 90 pediatric patients undergoing laparoscopic endorectal pull-through Soave procedures for HD.
- Comparison of three techniques: CLP (n=30), SILP (n=28), and H-SILP (n=32).
- Evaluation of clinical data, cosmetic results, and surgeon ergonomics.
Main Results:
- All three approaches demonstrated similar clinical outcomes, including blood loss, hospital stay, and postoperative complications.
- Operative times were comparable for younger patients and short-segment HD; CLP and H-SILP were faster for older/long-segment HD patients compared to SILP.
- SILP offered the best cosmetic outcome (scarless), followed by H-SILP (near scarless) and CLP (visible scars).
Conclusions:
- Laparoscopic approaches for Hirschsprung's disease yield comparable clinical outcomes.
- The choice of technique should be individualized based on patient age, disease extent, and cosmetic considerations.
- H-SILP offers a balance between cosmetic benefits and ergonomic efficiency.
Aim:
To report the clinical outcomes and ergonomics analysis of three laparoscopic approaches in the management of Hirschsprung's disease (HD).
Methods:
There were 90 pediatric patients (63 boys, 27 girls; mean age: 3.6 ± 2.7 mo; range: 1.0-90.2 mo) who underwent laparoscopic endorectal pull-through Soave procedures for short- and long-segment HD in our hospital. Three laparoscopic approaches were used: conventional laparoscopic pull-through (CLP) in 30 patients between 2009 and 2013, single-incision laparoscopic pull-through (SILP) in 28 patients between 2010 and 2013, and hybrid single-incision laparoscopic pull-through (H-SILP) in 32 patients between 2011 and 2013. We applied the hybrid version of the single-incision approach in 2011 to preserve the cosmetic advantage of SILP and the ergonomic advantage of CLP. We retrospectively analyzed the clinical data, cosmetic results, and ergonomics of these three approaches to have a better understanding of the selection of one approach over another.
Results:
The CLP, SILP, and H-SILP groups were similar in regard to age, sex, transition zone, blood loss, hospital stay, and intraoperative complications. Early and late postoperative results were not different, with equal daily defecation frequency and postoperative complications. No conversion to open technique was needed and none of the patients had recurrent constipation. With proper training, the ergonomics challenges were overcome and similar operative times were registered for the general operative time in the patients < 1 year of age and the short-segment HD patients. However, significantly shorter operative times were registered compared to SILP for patients > 1 year of age (CLP and H-SILP: 120 ± 15 min and 119 ± 12 min, respectively, vs 140 ± 7 min; P < 0.05) and for long-segment HD patients (152 ± 3.5 min and 154 ± 3.6 min, respectively, vs 176 ± 2.3 min; P < 0.05). The best cosmetic result was registered with the SILP (scarless), followed by the H-SILP (near scarless appearance) and the CLP (visible scars) procedures.
Conclusion:
Based on the results, we believed that the laparoscopic approach should be selected according to the age, transition zone, and desired cosmetic result.
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