Endoscopic Transanal Soave Procedure (ETaS) Using a LAPPROTECTOR for Hirschsprung Disease

Short-segment Hirschsprung disease is usually managed by a transanal Soave procedure, sometimes with laparoscopic assistance when proximal mobilization is difficult. We describe endoscope-assisted transanal Soave (ETaS) using a Lap Protector-based access platform without laparoscopy. A 6-year-old boy with constipation since infancy underwent surgery after rectal mucosal biopsies at ages 3 and 5 showed positive acetylcholinesterase staining. Mucosectomy was started 5 mm proximal to the dentate line and extended ~2 cm before closure of the distal cuff. A sealed transanal endoscopic workspace was then created with a LAPPROTECTOR and EZ-Access, allowing deep pelvic dissection and proximal mobilization to the sigmoid-descending junction under stable pneumorectum. After confirmation of mesenteric orientation and ganglion cells on frozen-section full-thickness biopsy, coloanal anastomosis was completed. Operative time was 225 min with minimal blood loss, no abdominal ports, and an uneventful postoperative course. This technique may be a useful option in selected pediatric patients.