Can the Swenson, Duhamel, and Soave-Boley Procedures Be Applied in an Era of Minimally Invasive Surgery? The Results of an Experimental Study

Abstract

Background: The purpose of this experimental study was to explore if, at this point in modern technology, the predominant techniques used for the treatment of Hirschprung disease (Swenson, Duhamel, and Soave-Boley) can be achieved laparoscopically, without laparotomy. Methods: Sixteen male pigs, weighing 15-25 kg each, were included in our trial experiment. We developed an experimental model and laparoscopically applied the rectosigmoidectomy (Swenson technique), the endorectal pull-through (Soave-Boley technique), and the retrorectal pull-through (Duhamel procedure) as well as the transanal mucosectomy of the rectum. We then recorded the techniques and the outstanding characteristics that evolved during their laparoscopic application. Results: The experimental animals had an uneventful postoperative course. The coloanal anastomosis was free of tension, airtight, and without stenosis regardless of the procedure used, in all the animals. Feeding was started following postoperative normal bowel movements. Median followup was three months and stool output was normal. Conclusions: In the surgical treatment of Hirschsprung disease the abdominal stage of the various operations can be carried out laparoscopically. The operating time of transanal mucosectomy can be significantly diminished if devascularization of the bowel is performed laparoscopically. The transanal mucosectomy of the rectum according to Georgeson is a modification of the Soave-Boley technique and it is the chosen mode of treatment for patients undergoing endorectal anastomosis.