Hirschsprung's disease and mini-invasive surgery.

Study aim: The treatment of Hirschsprung's disease was improved by the lapa roscopic approach. The study aim was to report the results of a short serie s. Patients and method. From December 1996 to January 2000, 13 children (7 boy s and 6 girls) were operated for a Hirschsprung's disease with a laparoscop ic approach. The mean age at the the time of surgery was 6 months. A colost omy had been performed previously in 10 of them. The colostomy was closed a nd the colorectal anastomosis was performed with Duhamel's technique in 10 and Swenson's in 3. Location of aganglionnic bowel was rectum and sigmoid c olon (n=9) rectum (n=2) left colon (n=l), left colon and right transverse c olon (n=1). Results: The mean duration of the procedure was 160 minutes. One conversion to laparotomy was necessary. One postoperative leak required a temporary c olostomy. One intestinal occlusion due to an incarceration of an intestinal loop behind the pulled through colon, required a reoperation. The mean 26 month-follow-up was too short to draw conclusions about functional results. Conclusion: Laparoscopic approach was an important progress in the treatmen t of the Hirschsprung's disease but, more recently, the transanal approach that we used in the last five patients, seems to be another more important innovation. (C) 2001 editions scientifiques et medicales Elsevier SAS.