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Laparoscopic pull-through procedures using the harmonic scalpel in infants and children with Hirschsprung's disease
1Presbyterian/St Luke's Medical Center for Children, Denver, CO, USA.
Insights
A new one-stage laparoscopic pull-through procedure offers a safe and effective alternative for treating Hirschsprung's disease (HSCR) in infants. This minimally invasive approach significantly reduces hospital stays and complications compared to traditional multi-stage surgeries.
Area of Science:
- Pediatric Surgery
- Minimally Invasive Surgery
- Gastroenterology
Background:
- Hirschsprung's disease (HSCR) traditionally requires multi-stage surgical treatment.
- This conventional approach involves multiple hospitalizations and extended recovery periods.
- Significant morbidity is associated with the traditional multi-stage surgical algorithm.
Purpose of the Study:
- To evaluate the safety and efficacy of a one-stage laparoscopic pull-through procedure for HSCR.
- To assess the feasibility of a minimally invasive approach for HSCR treatment.
- To compare outcomes with traditional multi-stage surgical methods.
Main Methods:
- A cohort of 15 infants and children underwent a one-stage laparoscopic pull-through procedure.
- The laparoscopic surgery utilized three or four ports and an ultrasonic dissector.
- Transrectal submucosal dissection and hand-sewn anastomosis were performed.
Main Results:
- The average operative time was 2 hours and 50 minutes.
- Patients experienced short recovery times, with average time to feeds at 1.3 days and discharge at 3.4 days.
- All patients achieved spontaneous daily stool excretion with no episodes of colitis; one patient had an anastomotic stricture.
Conclusions:
- The one-stage laparoscopic pull-through procedure is a safe and effective surgical option for Hirschsprung's disease.
- This minimally invasive technique reduces patient morbidity and hospital stay.
- Further investigation and long-term follow-up are warranted for this approach.
Abstract:
Hirschsprung's disease in infants has routinely been treated by a three- or four-stage process requiring a rectal biopsy, diverting colostomy, pull-through procedure, and then colostomy takedown. This algorithm requires multiple hospitalizations and surgeries over several months. The authors have adopted a laparoscopic approach that allows the surgery to be performed in one stage with a marked decrease in morbidity and hospital stay. From March 1995 to May 1996, 15 infants and children, ages 7 days to 8 years and weighing 2.3 kg to 40 kg, underwent laparoscopic pull-through procedures. Eleven underwent primary pull-through, while four underwent a previous diverting colostomy. The laparoscopic portion of the pull-through was performed using three or four ports, size 3.5 mm or 5 mm and an ultrasonic dissector. The final submucosal dissection was performed transrectally starting 1 cm above the pectinate line. The rectal anastomosis was hand sewn, and no patient was left with a diverting colostomy. Operative time averaged 2 hours and 50 minutes. Average time to feeds was 1.3 days and the average days to discharge was 3.4. There was one intraoperative pathology misdiagnosis and one patient with an anastomotic stricture. All patients are excreting stools spontaneously at least daily and there have been no episodes of colitis. This preliminary report shows that the one-stage laparoscopic pull-through is safe and effective.
