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Primary Laparoscopic-Assisted Endorectal Pull-Through for Hirschsprung's Disease

Byung-Soon Park, M.D., Ji-Young Sul, M.D.
Journal of the Korean Association of Pediatric Surgeons 2013;19(2):130-139.
Published online: December 24, 2013

Department of Surgery, Chungnam National University School of Medicine, Daejeon, Korea.

Correspondence: Ji-Young Sul, M.D., Department of Surgery, Chungnam National University School of Medicine, 282 Munhwa-ro, Jung-gu, Daejeon 301-721, Korea. Tel: 042)280-7182, Fax: 042)257-8024, jysul@cnu.ac.kr
• Received: October 24, 2013   • Accepted: November 30, 2013

Copyright © 2013 Korean Association of Pediatric Surgeons

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  • The application of laparoscopic techniques for the surgical management of Hirschsprung's disease is the recent trend. We described the surgical technique and postoperative long-term outcomes of the one-stage, laparoscopic-assiseted endorectal pull-through operation for Hirschsprung's disease. The technique uses three to four small abdominal ports. Laparoscopic mobilization of the sigmoid colon and rectum is performed and marginal artery-preserving colon pedicle is prepared. The rectal mobilization is performed using a transanal endorectal sleeve technique. The anastomosis is performed 0.5~1 cm above the dentate line. The age at surgery ranged from 6 days to 4 years. The average operative time was 144 minutes. Almost all of the patients passed stool and flatus within 36 hours of surgery. The average hospital stay after surgery was 6.5 days. Among 42 patients, 32 patients older than 3 years old were evaluated for function on defecation. All 32 patients have been continent, of those who needed laxatives were 11 (34.3%) due to constipation and overflow incontinence. Four children (12.5%) have remained dependent on laxatives. Laparoscopic-assisted endorectal pull-through operation for Hirschsprung's disease appears to be safe, provides the less pain, shorter time to full feeding, shorter hospital stay, and excellent cosmetic outcomes. Helping patients and parents ensure the quality of life, they should be provided with counseling, education, and longer-term follow-up care.
  • Keywords: Hirschsprung's disease; One-stage; Laparoscopic-assisted endorectal pull-through; LAERPT
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Table 1
General Patients and Surgical Characteristics
jkaps-19-130-i001.jpg
Table 2
Early Postoperative Complications (<3 Months after Surgery)
jkaps-19-130-i002.jpg
Table 3
Late Postoperative Complications and Long-term Outcomes (>3 Months after Surgery)
jkaps-19-130-i003.jpg
Table 4
Functional Results of Krickenbeck Assessment (N=32 Patients >3 Years Old)

*Voluntary bowel movement: feeling of urge, capacity to verbalize, hold the bowel movement

†Soiling: Grade 1 occasionally (once or twice per week); Grade 2 every day, no social problem; Grade 3 constant, social problem

+Constipation: Grade 1 manageable with diet; Grade 2 requires laxatives; Grade 3 resistant to diet and laxatives

jkaps-19-130-i004.jpg

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Primary Laparoscopic-Assisted Endorectal Pull-Through for Hirschsprung's Disease
J Korean Assoc Pediatr Surg. 2013;19(2):130-139.   Published online December 24, 2013
DOI: https://doi.org/10.13029/jkaps.2013.19.2.130
Download Citation

Download a citation file in RIS format that can be imported by all major citation management software, including EndNote, ProCite, RefWorks, and Reference Manager.
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Include:
Primary Laparoscopic-Assisted Endorectal Pull-Through for Hirschsprung's Disease
J Korean Assoc Pediatr Surg. 2013;19(2):130-139.   Published online December 24, 2013
DOI: https://doi.org/10.13029/jkaps.2013.19.2.130
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Primary Laparoscopic-Assisted Endorectal Pull-Through for Hirschsprung's Disease
Primary Laparoscopic-Assisted Endorectal Pull-Through for Hirschsprung's Disease

General Patients and Surgical Characteristics

Early Postoperative Complications (<3 Months after Surgery)

Late Postoperative Complications and Long-term Outcomes (>3 Months after Surgery)

Functional Results of Krickenbeck Assessment (N=32 Patients >3 Years Old)

*Voluntary bowel movement: feeling of urge, capacity to verbalize, hold the bowel movement

†Soiling: Grade 1 occasionally (once or twice per week); Grade 2 every day, no social problem; Grade 3 constant, social problem

+Constipation: Grade 1 manageable with diet; Grade 2 requires laxatives; Grade 3 resistant to diet and laxatives

Table 1 General Patients and Surgical Characteristics
Table 2 Early Postoperative Complications (<3 Months after Surgery)
Table 3 Late Postoperative Complications and Long-term Outcomes (>3 Months after Surgery)
Table 4 Functional Results of Krickenbeck Assessment (N=32 Patients >3 Years Old)

*Voluntary bowel movement: feeling of urge, capacity to verbalize, hold the bowel movement

†Soiling: Grade 1 occasionally (once or twice per week); Grade 2 every day, no social problem; Grade 3 constant, social problem

+Constipation: Grade 1 manageable with diet; Grade 2 requires laxatives; Grade 3 resistant to diet and laxatives

Table 1

Table 2

Table 3

Table 4

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