Page 10 - WJOLS - Journal of Laparoscopic Surgery

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WJOL
WJOLS

10.5005/jp-journals-10033-1313
Laparoscopic Management of Hirschsprung’s Disease
REVIEW ARTICLE

Laparoscopic Management of Hirschsprung’s Disease

KM Rita

ABSTRACT Surgery, Indian Journal of Paediatric Surgery, Seminars in

Laparoscopy has improved the outcome and manage- Paediatric Surgery, and Annals of Surgery. The research
ment of Hirschsprung’s disease. The most commonly seen gave a wide range of research material of which relevant
Hirschsprung’s disease with transition zone in the rectosigmoid articles were selected. The criteria for selection of papers
is done in the neonatal period as one-stage transanal endorec-
tal pull-through (ERPT) procedure. In all other children, it must were the number of cases included in the study and the
be one-stage laparoscopy-assisted transanal pull-through pro- duration of study.
cedure. Advantage of a laparoscopic procedure is that a biopsy Swenson and Bill described surgery for Hirschsprung’s
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report of the level of transition zone and the normal ganglionic disease. Ever since, surgery has remained the cornerstone
segments is obtained before the dissection is begun. It allows
peritoneal dissection and isolation of marginal artery under for treatment of Hirschsprung’s disease. At the outset,
vision. Also adequate length of colon can be dissected free of the surgical procedure was a three-stage procedure. It
the attachments under vision. involved the formation of colostomy and after a period
Keywords: Hirschsprungs disease, Laparoscopy, Transition of colonic washouts, the second stage of anorectal pull-
zone. through was done, keeping a protective colostomy and
How to cite this article: Rita KM. Laparoscopic Management later, in a third stage, closure of the colostomy was done.
of Hirschsprung’s Disease. World J Lap Surg 2017;10(3):91-94.
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Soave described the endorectal pull-through pro-
Source of support: Nil cedure to exclude the disadvantages inherent to pelvic
Conflict of interest: None dissection.
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Duhamel described his procedure of rectal pull-
INTRODUCTION through and anastomosing with a part of aganglionic
rectum longitudinally. Later surgeons started removing
Twenty-five years back in the postoperative ward of our
pediatric surgical unit, there would have been at least one the colostomy along with the pull-through procedure and
child with both legs and arms tied to the four posts of a the surgery became a two-stage procedure.
bed, and a pair of straight arteries, larger than the child, The open abdominal procedure with anorectal
stuck into the anus, and the anxious and frightened mother pull-through was associated with various complica-
standing beside the bed with her hand stuck to the chin. tions. As it was the staged procedure and colostomy
Anybody can read what is happening in that mother’s was done first, the complications inherent to colostomy
mind. This was the situation of a child with Hirschsprung’s like stenosis, prolapse, and abdominal excoriation were
disease. Thanks to the gastrointestinal stapler, this situa- prone to occur even before the definitive procedure.
tion soon changed. In this article, I am reviewing various The complications of laparotomy like wound infec-
articles and studies to evaluate, further, how laparoscopy tions, intra-abdominal and pelvic abscesses, wound
has influenced the treatment of these children. dehiscence, leak at the anastomotic site, leading to long
hospital stay, and delayed complications like intestinal
AIM adhesions and stenoses at the anastomotic site needed
repeated hospital admissions. Enterocolitis was another
To assess whether laparoscopy has influence on the major problem and patients developed enterocolitis
outcome of treatment of Hirschsprung’s disease.
before and after surgery.
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MATERIALS AND METHODS Fontana et al in a study of 82 infants who had under-
gone Soave or Duhamel open procedures were reviewed
Research materials taken are the various articles pub- after 20 years. They found only 60 and 67% of the chil-
lished in PubMed, ScienceDirect, Journal of Paediatric dren had an uneventful recovery; 20 and 29% of them
needed reoperation, and short-term continence for
both was around 50% and became 100% continent about
Surgeon
15 years of age.
Department of General Surgery, ESI Hospital, Ernakulam So et al published that Hirschsprung’s disease in
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Kerala, India
the newborn does not mandate the performance of a
Corresponding Author: KM Rita, Surgeon, ESI Hospital preliminary colostomy. They treated enterocolitis by a
Ernakulam, Kerala, India, e-mail: drrita2310@ rediffmail.com
precise regimen of colonic irrigations and then did the
World Journal of Laparoscopic Surgery, September-December 2017;10(3):91-94 91