LAPAROSCOPIC SWENSON PULL-THROUGH - A COMPARISON WITH THE OPEN PROCEDURE

This study was performed to compare the standard open Swenson pull-thr ough (OSP) with the laparoscopic Swenson pull-through (LSP) for Hirsch sprung's disease. The Swenson pull-through was performed on eight pati ents with a rectosigmoid transition zone, during a 14-month period, us ing one camera port and three working ports. The results were compared with those of 10 patients with a similar lesion treated by the open p rocedure during an overlapping 19-month period. One laparoscopic proce dure was converted to the open version because of technical difficulti es. Both methods had a hand-sewn anastomosis approximately 1 cm above the pectinate line. The preoperative variables of age, weight, inciden ce of colostomy, and incidence of Down's syndrome were similar for the two groups. The operating time for LSP was similar to that for OSP (4 Hours 42 minutes v 4 hours 37 minutes, respectively; P = NS). Postope ratively, the laparoscopic group had a shorter hospital stay (5.25 v 8 .8 days; P < .05) and had a shorter period until the start of oral int ake (2.75 v 5 days; P < .05). The requirement for narcotic pain medica tion was similar (12.6 v 12.8 doses; P = NS). Early postoperative comp lications were more common in the open group (3 wound infections, 1 pr olonged ileus, and 1 anastomotic leak). No complications occurred in t he laparoscopic group. Late postoperative follow-up was too short to c ompare functional results. The authors conclude that the Swenson pull- through can be performed safely with the laparoscope, with reduced mor bidity. Copyright (C) 1996 by W.B. Saunders Company