Hybrid Single-Incision Laparoscopic Approaches for Endorectal Pull-Through in Hirschsprung's Disease.

Abstract

Transanal endorectal pull-through for Hirschsprung's disease (HD) is a relatively safe and feasible procedure in neonates and infants. However, overstretching on the anal sphincter and mesentery of the sigmoid colon might cause potential risk of impaired defecation function. Single-incision laparoscopic endorectal pull-through (SILEP) is technically feasible and safe in HD patients, offering a better cosmetic result. However, it is stressful for the surgeon in view of its low manipulability and poor visualization causing clashing of instruments, especially in older children or patients with long-segment aganglionosis. We developed an age- and type-appropriate technique of hybrid SILEP (H-SILEP) using a trocarless instrument via another abdominal stab incision to obtain further improvement of SILEP in selected HD patients. Between August 2010 and July 2013, 36 patients (24 boys and 12 girls, with a mean age of 3.9 months) with HD underwent H-SILEP. Patient age, gender, transitional zone, operative time, blood loss, and intraoperative and postoperative complications, as well as short- and long-term results, were assessed. Ten patients had transitional zone in the rectum, 17 patients in the sigmoid colon, and 9 patients in the descending colon. Neither additional ports nor conversion to laparotomy was required in these 36 patients. The mean operative time was 116 minutes. There was no major intraoperative complication. Perianal excoriation was the main early postoperative complication, which occurred in 9 patients. No anastomotic leak occurred. Postoperative enterocolitis occurred in 2 patients. There was no recurrent constipation. Follow-up for 6 months to 3 years in all patients showed an excellent cosmetic result. Our procedure is feasible and safe, and it is technically less challenging to perform H-SILEP in selected HD patients. Moreover, it is better to use additional instruments for ergonometric reasons.