Evaluation of laparoscopic surgery for Hirschsprung's disease from the standpoint of invasiveness and colonic motility: Prolapsing technique with extra-anal mucosectomy

Authors


Correspondence
Yasuhide Morikawa, Professor of Pediatric Surgery, Keio University School of Medicine, Tokyo, Japan. Tel: +81 3 5363 2593
Fax: +81 3 3353 1407
Email: ymorikaw@sc.itc.keio.ac.jp

Abstract

Objective: Laparoscopic pull-through has become the standard surgical modality for Hirschsprung's disease in the field of pediatric surgery. This article discusses the minimal invasiveness of the prolapsing technique. This technique allows mucosectomies to be performed under direct vision even at the deepest dissected portion because the procedure is conducted via an extra-anal approach.

Method: The laparoscopic prolapsing technique (Lap) is compared with the conventional open Soave technique in terms of the change in CRP and WBC, defecation function, both clinical and manometric, after surgery.

Results: As a result, the timing of surgery has become earlier and the patients younger. Soiling occurs in 33% of open Soave and 0% of Lap patients. Manometry after Lap. pull-through revealed a positive recto-anal inhibitory reflex in 39% and evoked high amplitude propagated contraction was demonstrated in 85% of patients.

Conclusion: These results suggest that the present technique, including minimal dissections of the mesentery and the preservation of pelvic nerves in combination with fine mucosectomy under direct vision, could be beneficial for postoperative anorectal function in patients with Hirschspurung's disease.

Ancillary