Primary laparoscopic-assisted endorectal colon pull-through for Hirschsprung's disease - A new gold standard

Objective To describe the surgical technique and early clinical results aft er a one-stage laparoscopic-assisted endorectal colon pullthrough for Hirsc hsprung's disease. Summary Background Data Recent trends in surgery for Hirschsprung's disease have been toward earlier repair and fewer surgical stages. A one-stage pul l-through for Hirschsprung's disease avoids the additional anesthesia, surg ery, and complications of a colostomy. A laparoscopic;assisted approach dim inishes surgical trauma to the peritoneal cavity. Methods The technique uses four small abdominal ports. The transition zone is initially identified by seromuscular biopsies obtained laparoscopically. A colon pedicle preserving the marginal artery is fashioned endoscopically . The rectal mobilization is performed transanally using an endorectal slee ve technique. The anastomosis is performed transanally 1 cm above the denta te line. This report discusses the outcome of primary laparoscopic pull-thr ough in 80 patients performed at six pediatric surgery centers over the pas t 5 years. Results The age at surgery ranged from 3 days to 96 months. The average len gth of the surgical procedure was 2.5 hours. Almost all of the patients pas sed stool and flatus within 24 hours of surgery. The average time for disch arge after surgery was 3;7 days. All 80 patients are currently alive and we ll. Most of the children are too young to evaluate for fecal continence, bu t 18 of the older children have been reported to be continent. Conclusion Laparoscopic-assisted colon pull-through appears to reduce perio perative complications and postoperative recovery time dramatically. The te chnique is quickly learned and has been performed in multiple centers with consistently good results.