EXTRA-ANAL MUCOSECTOMY - LAPAROSCOPIC-ASSISTED ENDORECTAL PULL-THROUGH USING A PROLAPSING TECHNIQUE

Background/Purpose: The mucosectomy of the aganglionic rectal mucosa h as been performed transabdominally in the Soave procedure. Recently, m ucosectomy with transanal approach was reported both in the laparoscop ic and the open surgical procedure. However, the operative view and wo rking field are restricted because the dissection has to be done in th e anal canal. The authors report an innovative approach, an extra-anal mucosectomy, to perform mucosectomy in the Soave procedure for Hirsch spung's disease in combination with the laparoscopic-assisted prolapsi ng technique. Methods: Four patients underwent laparoscopic surgery fo r Hirschsprung's disease with extra-anal mucosectomy between 1995 and 1997. One 10-mm and 5-mm ports were used throughout the operation. The rectum was pulled out through the anal canal to create a rectal prola pse and was divided outside the anal canal. The mucosectomy was perfor med in the everted rectal mucosa outside the anal canal to the level o f dentate line. The colon was sutured to the anal mucosa 2 mm above th e dentate line. Mean operative time was 3 hours. Results: The present technique made the whole mucosectomy possible under direct observation . Conclusion: The extra-anal mucosectomy in conjunction with a laparos copic-assisted prolapsing technique seems to be a safe and reliable mo dality in the surgical treatment of Hirschsprung's disease. Copyright (C) 1998 by W.B. Saunders Company.