Staged laparoscopic-assisted pull-through for Hirschsprung's disease.

Department of Pediatric Surgery, K.M. School of Postgraduate Medicine & Research, N.H.L. Municipal Medical College, V.S. Hospital, Ahmedabad, India.
Journal of Pediatric Surgery (Impact Factor: 1.38). 12/2003; 38(11):1667-9. DOI: 10.1053/spsu.2002.35350
Source: PubMed

ABSTRACT The authors report 3 cases of Hirschsprung's disease that were treated by laparoscopic-assisted transanal pull-through after a colostomy already had been performed. Two of these patients presented with severe enterocolitis, and a primary laparoscopic-assisted single-stage transanal pull through was not feasible. The third patient had a colostomy performed and was referred to us for a definitive procedure. Many centers over the world now perform laparoscopic-assisted single-stage pull-through as a primary modality of management for Hirschsprung's disease. But for a country like India, where patients with Hirschsprung's disease present or are referred late and frequently with enterocolitis, performing a primary procedure is not possible in all cases. However, this has been used as the definitive procedure after performing a diverting colostomy and histopathologic determination of the length of the aganglionic bowel. The procedure gives excellent results and permits early postoperative feeding, early hospital discharge, and good cosmetic results.

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    ABSTRACT: Background Of patients with HD, 75-80 % have rectosigmoid aganglionosis. Methods The basic principle in all surgical procedures is to bring the ganglionic bowel down to the anus. A one-stage pull-through operation (De la Torre-Mondragon) can be successfully performed in these patients using a transanal endorectal approach without opening the abdomen. Results and This procedure is associated with excellent clinical results and permits early postoperative conclusions feeding, early hospital discharge and no visible scars. The vast majority of patients treated with any one of the standard pull-through procedures achieve satisfactory continence and function with time. The attainment of normal continence is dependent on the intensity of bowel training, social background and respective intelligence of patients.