Early and late outcomes of primary laparoscopic endorectal colon pull-through leaving a short rectal seromuscular sleeve for Hirschsprung disease

A Microlaparoscopically Assisted Pull-Through Procedure for Hirschsprung's Disease: Initial Experiences

“…The benefits of laparoscopic access have been described as reduced traumatization, better visualization of the intra-abdominal anatomy during the pull-through procedure, and superior cosmesis postoperatively. 2,11,15 Various techniques and different modifications have been described with the goal of improving surgical outcomes. [2][3][4][5][6][7][8][9][10][11] Additionally, a debate has been raised about the necessity of an additional laparoscopic approach during the pull-through procedure.…”

“…2,11,15 Various techniques and different modifications have been described with the goal of improving surgical outcomes. [2][3][4][5][6][7][8][9][10][11] Additionally, a debate has been raised about the necessity of an additional laparoscopic approach during the pull-through procedure. The so-called natural orifice transluminal endoscopic surgery (NOTES) access in newborns during the pullthrough procedure, introducing 5.5-mm trocars for the 5-mm laparoscope and instruments transanally into the peritoneal cavity, 16 and transumbilical minilaparotomy 17 for colon dissection have been reported.…”

“…Laparoscopic access for mesocolon dissection was first described by Smith et al 1 in 1994 during a Duhamel procedure, and various techniques and modifications of different transanal pull-through techniques have been described since that time. [2][3][4][5][6][7][8][9][10][11] Previously, we had used a 5-mm scope inserted through the right lateral abdominal wall for visualization during the laparoscopic part of colon resection for HD. In 2005, a microlaparoscopic approach was introduced in our department for various procedures, and it has been successfully used instead of conventional laparoscopy in children.…”

Transanal endorectal pull-through for Hirschsprung’s disease using long cuff dissection and short V-shaped partially resected cuff anastomosis: early and late outcomes

“…In recent years, there have also been a number of ongoing changes in technique including various techniques of submucosal dissection and how to deal with the muscular cuff [6,8,13]. They were frequently discussed and were considered to have improved the long-term results, particularly with respect to continence and recurrent constipation.…”

“…Besides, performing a long cuff dissection would have its disadvantages, such as time-consuming, more risk of intraoperative bleeding [2,8]. Therefore, many surgeons have moved to a much more shorter cuff [9].…”