Laparoscopic Pull-through Procedure Research Articles

Primary laparoscopic endorectal pull-through procedure with or without a postoperative rectal tube for hirschsprung disease: a multicenter perspective study

BackgroundHirschsprung-associated enterocolitis (HAEC) is a significant complication of HD both in the pre- and postoperative periods. This was a large multicenter series study to determine the effect of preserving a postoperative rectal tube on preventing HAEC after primary laparoscopic endorectal pull-through procedure. MethodsBetween 2014 and 2017, a total of 383 consecutive patients with rectosigmoid segment HD were randomly divided into group A (n = 190) and group B (n = 193). All of them underwent primary laparoscopic pull-through procedure, with the same postoperative treatment protocols except for group A with a rectal tube after surgery for 5 days, while group B did not have it. The mean time of follow-up was 2.0 ± 0.53 years (0.5–3.6 years). Demographics, operative data, postoperative complications, and clinical outcomes were compared between these two groups. ResultsOutcomes within 1 month after surgery indicated a lower incidence of abdominal distention (4% vs 15.5%, P < 0.05) and postoperative HAEC (1.2% vs 6.8%, P < 0.05) in group A compared to group B. Beyond 1 month after surgery, the overall incidence of HAEC was not significantly different (12% vs 13.1%, P = 0.54). However, further analysis revealed that the patients who suffered HAEC twice or above twice in group A were significantly less than those in group B (3.6% vs 8.3%, p = 0.02). There were no significant differences in the defecation frequency and other complications. ConclusionsPrimary laparoscopic endorectal pull-through procedure with a postoperative rectal tube can reduce the early-stage postoperative incidence of abdominal distension and HAEC and the risk of HAEC recurrence in the long term, and is beneficial to postoperative management. Level of evidenceLevel 2.

Primary laparoscopic pull-through procedure for Hirschprung disease at a low resource setting: Experience and early results

The Journal is the primary organ of Continuing Paediatric Medical Education in Sri Lanka. The journal also has a website. Free full text access is available for all readers.The Sri Lanka Journal of Child Health is now indexed in SciVerse Scopus (Source Record ID 19900193609), Index Medicus for South-East Asia Region (IMSEAR), CABI (Centre for Agriculture and Bioscience International Global Health Database), DOAJ and is available in Google, as well as Google Scholar.The policies of the journal are modelled on the Committee on Publication Ethics (COPE) Guidelines on Principles of Transparency and Best Practice in Scholarly Publishing. Sri Lanka Journal of Child Health is recognised by the International Committee of Medical Journal Editors (ICMJE) as a publication following the ICMJE Recommendations.

Transumbilical laparoscopic pull-through for children with hypoganglionosis

To investigate the surgical outcomes after on transumbilical laparoscopic pull-through procedure for pediatric hypoganglionosis(HYP). Twelve children with HYP had received transumbilical laparoscopic pull-through procedure from June 2009 to June 2010. Specially designed curved and elongated laparoscopic instruments were used during the procedures. All the patients were followed up over 10 months. Data were collected and analyzed. The diagnosis of hypoganglionsis was pathologically confirmed. No conversions to laparotomy or traditional laparoscopic surgery were required and there were no damages to the abdominal blood vessels, intestine, ductus deferens, or ureters. The average duration of operation was 140 min. The mean intraoperative blood loss was 45 ml. The mean length of specimen was 40 cm. Postoperatively there were no complications such as anastomotic leak, anastomotic stricture, constipation, seepage, or fecal in continence. The average hospital stay after surgery was 9 days. During 10 to 22 months of follow-up(median 16 months), no postoperative recurrence was noticed. No obvious scar was seen 1 months after surgery. It is safe and effective for children with hypoganglionosis to undergo transumbilical laparoscopic pull-through procedure.

Laparoscopic Abdominoanal Pull-through Procedure for Male Patients With Lower Rectal Cancer After Chemoradiation Therapy

Abdominoanal pull-through procedure is an alternative procedure for lower rectal cancer in which double-stapling technique is difficult to apply and/or the adequate distal safety margin (>2 cm) cannot be achieved in a very narrow male pelvis. The present study is to examine if the pull-through procedure can be effectively performed by laparoscopic approach for male lower rectal cancer downstaged by concurrent chemoradiation therapy. A total of 14 male patients with advanced lower rectal cancer (Stage II: n=6; Stage III: n=8, by tumor, node, and metastasis staging system of International Union Against Cancer) and successfully downstaged by preoperative concurrent chemoradiation therapy were accrued for this study. All patients underwent three-staged operation including: transverse-colostomy creation before concurrent chemoradiation therapy, laparoscopic pull-through procedure and closure of colostomy. The details of laparoscopic pull-through procedure were shown in the video including: total mobilization for rectum in the fashion of total mesorectal excision, retrieval and transection of bowel through an incision over dentate line, and coloanal anastomosis. The surgical outcome of the patients were prospectively evaluated. Although the dissection plane is a little blurred by preoperative concurrent chemoradiation therapy, the laparoscopic pull-through procedure was preformed with acceptable operation time (274.6+/-52.4 minutes, mean+/-standard deviation) and little blood loss (104.5+/-32.0 ml) through 5 small wounds of abdominal ports. The number of dissected lymph node was 17.0+/-3.0. The distal safety margin of all patients was more than 2 cm. The patients have quick functional recovery, as evaluated by the length of postoperative ileus (48.0+/-8.0 hours), hospitalization (9.0+/-1.0 days), and degree of postoperative pain (3.5+/-0.5, visual analog scale). There were no major postoperative complications yet postoperative fever developed in one patient and wound infection in the other one. Besides the expenses covered by the National Bureau of Health Insurance in Taiwan, the patient had to pay extra expenses of NT$25000.0+/-3500.0 (1.0 US dollars=32.0 NT$). During the follow-up periods (median: 10 months, range, 4 to 16 months), one patient developed a recurrent lung metastasis. In view of the good functional recovery and fine short-term oncologic results, laparoscopic pull-through procedure was thus a good choice for downstaged male lower rectal cancer in terms of sphincter-preservation and enough distal section margin of tumor.

Laparoscopic pull through for Hirschsprung′s disease in infants

<b>Purpose</b>: To report personal experience with Primary Laparoscopic Pullthrough Procedure (PLPP) in infants with Hirschsprung's Disease (H.D.).<br><b>Materials and Methods: </b> Sixty four PLPP were performed by the author. In addition, 17 assisted LPP were done but not reported herein. The patients' personal and anatomic data were typical for babies with H.D.<br><b>Results: </b> Average age at operation was seven weeks (range 1-28 weeks). Operative time for PLPP averaged 140 minutes. Two babies required conversion to a standard laparotomy for anatomic reasons (long segment). Average blood loss was <5 ml. No intraoperative nor immediate post operative complications were seen. Hospitalization was short (2-3 days). Two had mild diarrhea episodes which improved without hospitalization. Another child developed a severe problem with enterocolitis 3½ years following the operation. In general, stool habits fell within the normal range for those > 4 years of age.<br><b>Conclusion: </b> PLPP is an effective, problem free approach for treating neonatal H.D. It has replaced the standard two stage open procedure in babies with uncomplicated presentation.<br>

Laparoscopic Swenson procedure—an optimal approach for both primary and secondary pull-through for Hirschsprung’s disease

Background/purpose Several pull-through procedures are available for the surgical management of Hirschsprung’s disease (HD) in children. The authors have adopted a laparoscopic approach since 1995, including laparoscopic Swenson procedure (LSw), both for one-stage primary and 2-stage secondary procedures. The aim of this study was to examine the role of LSw in children with HD in both primary and secondary procedures. Methods From January 1995 to December 2001, 42 children with biopsy-proven HD underwent laparoscopic pull-through procedure for HD. This group included 29 children who underwent LSw, a detailed analysis of which forms the basis of this report. Results Sixteen children underwent a single-stage neonatal LSw; the median weight of this group at the time of surgery was 3.2 kg and the median age was 5 days. Secondary LSw was performed in the remaining 13 children, which included 3 children with total colonic HD who underwent laparoscopic total colectomy and LSw. The median operating time was 105 minutes (range, 66 to 175 minutes). The median time to commence full diet was 48 hours (range, 24 to 86 hours), and median time to return to normal play and activity was 72 hours (range, 48 hours to 5 days). There was no difference in operating time between primary and secondary pull-through procedures. There were no intraoperative complications, and no patient required open conversion. Postoperative ileus was noted in 3 children and enterocolitis in 2. The median hospital stay was 4 days (range, 2 to 6 days). Follow-up was between 6 months to 7 years with a median follow-up of 2.2 years. At follow-up, 2 children required laparoscopic antegrade continence enema procedure. A satisfactory continence was noted in 15 of the 19 children who were older than 3 years at the time of last follow-up. Conclusions LSw seems to be a suitable procedure for laparoscopic management of HD in children. LSw is safe and effective, both for primary and secondary type of pull-through procedures, with good short-term results.

The Status of Primary Laparoscopic Pullthrough Procedure (PLPT) in Neonates with Hirschsprung's Disease

Pediatric Endosurgery & Innovative TechniquesVol. 2, No. 4 The Status of Primary Laparoscopic Pullthrough Procedure (PLPT) in Neonates with Hirschsprung's DiseaseJUDA Z. JONAJUDA Z. JONASearch for more papers by this authorPublished Online:15 Mar 2009https://doi.org/10.1089/pei.1998.2.177AboutSectionsPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail FiguresReferencesRelatedDetails Volume 2Issue 4Jan 1998 To cite this article:JUDA Z. JONA.The Status of Primary Laparoscopic Pullthrough Procedure (PLPT) in Neonates with Hirschsprung's Disease.Pediatric Endosurgery & Innovative Techniques.Jan 1998.177-180.http://doi.org/10.1089/pei.1998.2.177Published in Volume: 2 Issue 4: March 15, 2009PDF download