Primary laparoscopic endorectal colon pull-through for Hirschsprung's disease: early results of 61 cases

OBJECTIVE: To report early results after a one-stage laparoscopic endorectal colon pull-through for Hirschsprung's disease (HD). METHODS: Between January 2002 and June 2004, 61 patients underwent primary laparoscopic-assisted endorectal colon pull-through procedure for HD. Ages ranged from 21 days to 36 months. The ganglionic and aganglionic segments were initially identified by seromuscular biopsies obtained laparoscopically. The rest of the procedure was performed according to Georgeson's technique. We left a short rectal seromuscular sleeve 2 cm from the dentate line. RESULTS: The aganglionic segment was located in the rectum in 33 patients, in the sigmoid colon in 27 patients and in the left colon in one patient. The median operating time was 140 minutes. There were no operative complications or deaths. No conversion was required. There was minimal blood loss during surgery. Clear fluids were given 12 hours after surgery and milk was given on the 2nd day. In one patient, small intestinal perforation occurred 3 days after surgery and required ileostomy. The median hospital stay was 6 days, excluding one patient with intestinal perforation. Spontaneous defaecation occurred in all patients before discharge. CONCLUSION: One-stage laparoscopic-assisted colon pull-through is a safe and effective procedure for HD.