One-stage laparoscopy-assisted endorectal pull-through for late presented Hirschsprung's disease—Case series. (2015)

• Record Type: Journal Article
• Authors: Nam, So Hyun; Cho, Min Jeong; Kim, Dae Yeon
• Is Part Of: International journal of surgery case reports. Volume 16(2015)Supplement
• Page Start: 162
• Page End: 165
• Publication Date: 2015
• Subjects: Hirschsprung's disease -- Children -- Laparoscopy; Surgery -- Periodicals; Surgical Procedures, Operative -- Periodicals; Surgery; Electronic journals; Periodicals; 617.005
• DOI: 10.1016/j.ijscr.2015.09.005
• Languages: English
• ISSNs: 2210-2612

Abstract

Highlights: The operation of Hirschsprung's disease in children older than 3 years is traditionally staged operation with enterostomy because of severe dilated bowel. We did one stage laparoscopy-assisted endorectal pull-through with short segment Hirschsprung's disease for late presented children. One stage laparoscopy-assisted endorectal pull-through is safe with excellent cosmetic benefit. Constipation is still concerning problem for late presented HD, but it is comparable with staged operation. Abstract: Introduction: Children with late-presenting Hirschsprung's disease (HD) are classically treated by a staged operation with enterostomy. An alternative may be one-stage laparoscopy-assisted endorectal pull-through, which has cosmetic advantages. This case-series report describes the outcomes of children with late-presenting HD who underwent this procedure. Presentation of cases: Eight older (>3 years) children (five males, three females) underwent one-stage laparoscopy-assisted endorectal pull-through in 2010–2012. A retrospective review revealed their median age was 9.9 (range, 3.4–14) years. The transitional zone was rectosigmoid junction in 4 patients, and was rectum in 4 patients. For bowel preparation, five patients required rectal irrigation under general anesthesia. The median operating time was 263 min. There were no intraoperative or early post-operative complications. Patients started a diet a median of 5 days after the operation and were discharged a median of 11.5 days. During the median follow-up period of 37 months, seven (87.5%) had acquired voluntary bowel movements and 12.5% had grade 1 soiling. However, five (62.5%) of the patients still had constipation. The constipation was manageable with diet or laxatives in four patients but one patient continued to require regular enemas. Discussion: One-stage laparoscopy-assisted endorectal pull-through in late-presenting HD was feasible, even in patients with large fecaloma with obstruction. Rectal irrigation under general anesthesia and the use of laparoscopy and a bipolar coagulator help to overcome the technical difficulties of this procedure. Conclusion: One-stage laparoscopy-assisted endorectal pull-through in children with late-presenting short segment HD is feasible and safe.