Laparoscopic colonic mapping of dysganglionosis

Retention of a proximal aganglionic segment or the unrecognized coexistence of other dysganglionoses may jeopardize the definitive surgical treatment of Hirschsprung's disease (HD). To assess the extent of the disease and/or the presence of other dysganglionoses without an additional laparotomy, we developed a laparoscopic-assisted technique to perform colonic full-thickne ss biopsies. After creation of a pneumoperitoneum, a 5-mm laparoscope is in serted in the supraumbilical area and a working 10/12-mm port is placed in the left iliac fossa. The sigmoid/descending colon is grasped and pulled th rough the abdominal wall and a full-thickness biopsy done. The same procedu re is applied to the transverse and ascending colon. Rectal and colonic bio psy specimens were studied using enzyme histochemical methods. Over the las t year, five children aged 7 months to 12 years with dysganglionosis underw ent laparoscopic-assisted mapping of the colon. Previous rectal suction bio psies were diagnostic of HD in three patients and suspicious of hypoganglio nosis in two. Proximal full-thickness biopsies revealed: normal colon in tw o cases of HD, coexistent type B intestinal neuronal dysplasia up to the de scending colon in the other case of HD; and hypoganglionosis up to the asce nding colon in the two patients with suspected hypoganglionosis. The proced ures were performed easily, the patients being discharged after 36 to 48 h with no complications. Four children have already undergone pull-through pr ocedures with resection of the affected colon in adhesion-free abdominal ca vities and did not develop constipation or enterocolitis. Laparoscopic-assi sted mapping of the entire colon is a simple, safe, and effective procedure that may contribute to improving the outcome of intestinal dysganglionosis by better characterization of the disease.