Laparoscopic and transanal pull-through for Hirschsprung disease
Section snippets
Minimal-access approaches
In the early 1990s, Georgeson5 described the first minimal-access approach to pull-through surgery for Hirschsprung disease. His operation consisted of a laparoscopic biopsy to identify the transition zone, laparoscopic mobilization of the rectum below the peritoneal reflection, a short endorectal mucosal dissection from below, and an anastomosis from below after prolapsing and excising the rectum. In general, four 3- to 5-mm ports are used, and the laparoscopic dissection is done using
Immediate neonatal pull-through versus waiting until the child is bigger
Approximately half of children with Hirschsprung disease present with neonatal intestinal obstruction and are diagnosed by rectal biopsy in the first month of life. Some surgeons prefer to wait until the child is a few months old before doing the procedure, with the rationale being that the operation will be technically easier and safer if the child is bigger and if the dilated proximal colon is decompressed. In some health care environments, this waiting period may be necessary because of
Outcomes after laparoscopic and transanal pull-through
Many series of children undergoing either laparoscopic or transanal pull-through have been published, from almost every continent, and both operations have been associated with excellent outcomes.12, 25, 26, 27, 28 Studies comparing the minimal-access approaches to open surgery have been less commonly reported; all have been retrospective and have shown shorter time to feeding, less pain, shorter hospital stay, and improved cosmetic result, with no difference in short- or long-term complication
References (40)
- et al.
A 40-year multinational retrospective study of 880 Swenson procedures
J Pediatr Surg
(1989) - et al.
Primary versus staged pull-through for the treatment of Hirschsprung disease
Semin Pediatr Surg
(2004) - et al.
Transanal endorectal pull-through for Hirschsprung's disease
J Pediatr Surg
(1998) - et al.
Transanal one-stage Soave procedure for infants with Hirschsprung's disease
J Pediatr Surg
(1999) - et al.
Swenson revisited: A one-stage, transanal pull-through procedure for Hirschsprung's disease
J Pediatr Surg
(2003) - et al.
Single-stage transanal endorectal pull-through for Hirschsprung's disease: Perspective from a developing country
J Pediatr Surg
(2007) - et al.
Correlation between radiographic transition zone and level of aganglionosis in Hirschsprung's disease: Implications for surgical approach
J Pediatr Surg
(2003) - et al.
Comprehensive review of procedures for total colonic aganglionosis
J Pediatr Surg
(2009) - et al.
Redo pull-through in Hirschsprung's [corrected] disease for obstructive symptoms due to residual aganglionosis and transition zone bowel
J Pediatr Surg
(2011) - et al.
Is daily dilatation by parents necessary after surgery for Hirschsprung disease and anorectal malformations?
J Pediatr Surg
(2012)
Rectal irrigations for the prevention of postoperative enterocolitis in Hirschsprung's disease
J Pediatr Surg
One-stage Soave pullthrough for Hirschsprung disease: A comparison of the transanal and open approaches
J Pediatr Surg
Transanal versus open endorectal pull-through for Hirschsprung's disease
J Pediatr Surg
Postoperative Hirschsprung's enterocolitis after minimally invasive Swenson's procedure
J Pediatr Surg
Persistent obstructive symptoms after surgery for Hirschsprung's disease: Development of a diagnostic and therapeutic algorithm
J Pediatr Surg
Hirschsprung disease and fecal incontinence: Diagnostic and management strategies
J Pediatr Surg
Endorectal pull-through for Hirschsprung's disease-a multicenter, long-term comparison of results: Transanal vs transabdominal approach
J Pediatr Surg
Development of a standardized definition for Hirschsprung's-associated enterocolitis: A Delphi analysis
J Pediatr Surg
Hirschsprung's disease; a new concept of the etiology; operative results in 34 patients
N Engl J Med
Critical analysis of the operative treatment of Hirschsprung's disease
Arch Surg
Cited by (42)
Bowel function after transanal endorectal pull-through for Hirschsprung disease – does outcome improve over time?
2020, Journal of Pediatric SurgeryBilateral hydrosalpinx in patients with Hirschsprung's disease
2018, Journal of Pediatric SurgeryCitation Excerpt :The first complete rectal resection and end-to-end anastomosis for patients with HD were reported by Swenson in the late forties. Since then techniques have evolved to less aggressive, one-stage, transanal or minimally invasive procedures, reducing the risk of abdominal contamination and intestinal adhesions, and minimizing damage to the pelvic structures [14–18]. The three muscular layers of the isthmic fallopian tube receive innervation from the pelvic plexi running through the uterosacral ligaments.
Comparison of laparoscopic excision versus open transvesical excision for symptomatic prostatic utricle in children
2016, Journal of Pediatric SurgeryCitation Excerpt :Owing to its advantages of less postoperative pain, shorter hospital stay, and improved cosmetics, laparoscopy has become the minimally invasive technique of choice in the adult population [4]. Pediatric laparoscopy has recently been developed for pelvic surgery, offering an excellent surgical view and good results [12,13]. Yeung et al. first reported the successful use of LE under cystoscopic guidance in 4 cases of PU [9].
Laparoscopic-assisted versus complete transanal pull-through using Swenson technique in treatment of Hirschsprung’s disease
2023, Annals of Pediatric Surgery