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  • Title: Early and late outcomes of primary laparoscopic endorectal colon pull-through leaving a short rectal seromuscular sleeve for Hirschsprung disease.
    Author: Hau BD, Quynh TA, Anh VH, Liem NT.
    Journal: J Laparoendosc Adv Surg Tech A; 2011; 21(1):81-3. PubMed ID: 21314566.
    Abstract:
    AIM: The aim of this study was to report early and late outcomes of primary laparoscopic-assisted endorectal colon pull-through leaving a short seromuscular sleeve for Hirschsprung disease (HD) in the newborn. METHODS: Laparoscopic endorectal colon pull-through was performed by using four ports. CO(2) insuffaltion pressure was around 8-10 mm Hg. The ganglionic and aganglionic segments were initially identified by seromuscular biopsies obtained laparoscopically. The rest of the procedure was carried out according to Georgeson's technique. However, we left a short rectal seromuscular sleeve of 1.5-2 cm above the dentate line. RESULTS: From January 2003 to August 2009, 47 patients were operated upon by the same surgeon. Ages ranged from 3 to 30 days. The aganglionic segment was located in the rectum in 31 patients, in the sigmoid colon in 15 children, and in the left colon in 1 patient. The median operating time was 124 minutes. There were no perioperative deaths. There was no conversion to open surgery. There was minimal blood loss during surgery. Oral intakes of clear fluid were started 12 hours after surgery and advanced to formula on the second day. The mean hospital stay was 5.1 days (range, 4-8). Follow-up, ranging from 4 to 72 months, was obtained in 42 patients. Thirty patients (71.4%) had 1-2 defecations/day, 10 (23.8%) had 3-4 defecations/day, and 1 (2.4%) had more than 4 defecations/day. Constipation occurred in 1 patient (2.4%) and enterocolitis in 1 patient (2.4%). No patient had anastomotic fistula. Intermittent urinary did not occur in any patient. Erectile function, evaluated by infant's parents, was presented in all 34 males who were followed up. CONCLUSIONS: Primary laparoscopic-assisted endorectal colon pull-through leaving a short rectal seromuscular sleeve is a safe, effective procedure for HD in the newborn.
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