Preanal stapler anastomosis in minimally invasive surgery of Hirschsprung's disease

The purpose of this experimental investigation was to optimize the laparoscopic variant of Swenson-Grob's procedure for treatment of Hirschsprung's disease using a circular stapler to perform the preanal anastomosis and to measure its tightness. Several methods of operative treatment of Hirschsprung's disease are described. In our laparoscopic study four methods were evaluated in 10 15-kg piglets. Swenson-Grobs procedure is one of the methods,which can be performed laparoscopically without any laparotomy and was used in this modification on 4 piglets. The laparoscopically mobilized colorectum was pre- anal prolapsed, preanal resected, and anastomosed in a special technique using a circular stapler. The prolapsed anastomosis was replaced into the abdominal cavity and laparoscopically peritonealized. We controlled the anastomosis position by laparotomy, then cut out the anastomosis and controlled its tightness by manometric air insufflation into the orally and aborally tightened bowel below water. In those 4 animals the position was correct and all anastomoses were tight up to a pressure of 40 mm Hg and more. We conclude that preanal stapler anastomosis improves the minimally invasive variant of Swenson-Grob's procedure to treat Hirschsprung's disease, because it minimizes the risk of anastomotic leakage and follows the rules of minimally invasive surgery, because there is no need of laparotomy.