Ten years' experience with laparoscopic-assisted endorectal Soave pull-through procedure with a short muscular cuff for Hirschsprung's disease

Abstract

Objective To summarize our experience with laparoscopic-assisted endorectal Soave pull-through (LAEPT) with a short and V shape split muscular cuff for Hirschsprung's disease (HD) over 10 years. Methods The clinical course of 218 patients who underwent modified LAEPT for HD were reviewed. LAEPT was performed accoding to the technique described by Georgeson. Some technical modifications were made including less dissection of the bottom of the pelvic, rectal mucosa dissection with a long cuff and coloanal anastomosis with a short cuff and a V shape split in the posterior wall of the muscular cuff. Results From September 1999 to Jun 2010, 218 patients were operated on by the same surgical team. Patients' age ranged from 15 days to 12 years old. The aganglionic segment was located in the rectum or sigmoid colon in 176 patients, in the left colon in 38 children, and in the transverse colon in 4 patients. The median operating time was 176 minutes. Conversion to open surgery occurred in 2 patients. Bleeding of left iliac vein occurred in 1 patient and a 180 twist of the neorectum occured in 2 cases. Median time for first bowel movement after surgery was 23 hours. Median postoperative hospital stay was 10.4 days. Median daily stool frequency was 4.6 times within the first two weeks after surgery, and reduced to 2.3 times 3 months after surgery. The immediate postoperative complications included intestine herniated from trocar site in 2 patients, perianal excoriation in 52 patients, and anastomotic leakage in 3 patients. The 182 patients were followed up for 6 to 120 months. Late postoperative complications included postoperative adhesive bowel obstruction (1.1 ％), enterocolitis (9.3 ％), anastomostic stenosis (2.2 ％ ), constipation (2.2 ％ ), and soiling (4.4％ ). Excellent and good bowel function was achieved in 87％ patients. Conclusions Laparoscopic-assisted endorectal Soave pull-through with a short and V shape split muscular cuff is a safe and effective procedure for HD. Key words: Hirschsprung's disease; Laparoscopic surgery operation