Laparoscopically Assisted Pull-Through Operation for Hirschsprung’s Disease

Abstract

For patients with longer segment Hirschsprung’s disease (HSCR), the bowel lacking ganglion cells is unable to be removed adequately by transanal pull-through operation alone. Several years ago, the dilated bowel had to be dissociated by a laparotomic procedure which left striking scars and severe trauma. Recently, advances in laparoscopic techniques and instruments provide minimally invasive possibilities for the management of patients with long-segment HSCR, total colonic aganglionosis, and allied HSCR disorders. The three most popular procedures, Soave, Duhamel, and Swenson, have been proven to be feasible under laparoscopic assistance, and a series of modified operations, such as heart-shaped anastomosis, have also been shown to be successful and effective. Laparoscopy has also been shown to be feasible for reoperation. With the advantages of better cosmetics, less secondary injuries, shorter hospital stay, and easier biopsy, increasingly more pediatric surgeons have made the laparoscopic procedure their first choice for children with HSCR, especially for long-segment disease. This chapter will give up-to-date knowledge on the indications, procedures, and complications of the laparoscopically assisted pull-through operation for HSCR.