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One-stage laparoscopy-assisted endorectal pull-through for late presented Hirschsprung's disease-Case series
So Hyun Nam1, Min Jeong Cho2, Dae Yeon Kim3
1Department of Surgery, Dong-A University College of Medicine, Dong-A University Hospital, Republic of Korea.
Insights
One-stage laparoscopy-assisted endorectal pull-through is a feasible and safe surgical option for children with late-presenting Hirschsprung
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Surgical Innovation
Background:
- Late-presenting Hirschsprung's disease (HD) traditionally managed with staged surgery and enterostomy.
- One-stage laparoscopy-assisted endorectal pull-through offers potential cosmetic advantages.
- This study evaluates outcomes of this minimally invasive approach in older children with HD.
Purpose of the Study:
- To assess the feasibility and safety of one-stage laparoscopy-assisted endorectal pull-through in late-presenting HD.
- To describe the surgical outcomes and long-term results in a cohort of older children.
Main Methods:
- Retrospective review of eight children (>3 years) undergoing one-stage laparoscopy-assisted endorectal pull-through (2010-2012).
- Analysis of operative details, including bowel preparation (rectal irrigation in 5 patients), operative time, and complications.
- Evaluation of postoperative recovery, bowel function, soiling, and constipation during a median 37-month follow-up.
Main Results:
- No intraoperative or early postoperative complications observed.
- Median hospital stay was 11.5 days; median time to diet initiation was 5 days.
- At follow-up, 87.5% achieved voluntary bowel movements, but 62.5% experienced manageable constipation.
Conclusions:
- One-stage laparoscopy-assisted endorectal pull-through is a feasible and safe approach for late-presenting HD, even with obstruction.
- Techniques like rectal irrigation and laparoscopic bipolar coagulation facilitate the procedure.
- The approach demonstrates good functional outcomes regarding bowel movements, though constipation remains a concern.
Introduction:
Children with late-presenting Hirschsprung's disease (HD) are classically treated by a staged operation with enterostomy. An alternative may be one-stage laparoscopy-assisted endorectal pull-through, which has cosmetic advantages. This case-series report describes the outcomes of children with late-presenting HD who underwent this procedure.
Presentation Of Cases:
Eight older (>3 years) children (five males, three females) underwent one-stage laparoscopy-assisted endorectal pull-through in 2010-2012. A retrospective review revealed their median age was 9.9 (range, 3.4-14) years. The transitional zone was rectosigmoid junction in 4 patients, and was rectum in 4 patients. For bowel preparation, five patients required rectal irrigation under general anesthesia. The median operating time was 263min. There were no intraoperative or early post-operative complications. Patients started a diet a median of 5 days after the operation and were discharged a median of 11.5 days. During the median follow-up period of 37 months, seven (87.5%) had acquired voluntary bowel movements and 12.5% had grade 1 soiling. However, five (62.5%) of the patients still had constipation. The constipation was manageable with diet or laxatives in four patients but one patient continued to require regular enemas.
Discussion:
One-stage laparoscopy-assisted endorectal pull-through in late-presenting HD was feasible, even in patients with large fecaloma with obstruction. Rectal irrigation under general anesthesia and the use of laparoscopy and a bipolar coagulator help to overcome the technical difficulties of this procedure.
Conclusion:
One-stage laparoscopy-assisted endorectal pull-through in children with late-presenting short segment HD is feasible and safe.
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