Laparoscopically assisted colorectal resection in Hirschsprung's disease.

BACKGROUND

Minimally invasive surgery (MIS) has been adapted to virtually every kind of abdominal operation. Colorectal resections of any extent are possible. The reduction in local and systemic surgical trauma in MIS suggests this method could be valuable for rectal resection for Hirschsprung's disease. -

METHOD: Diagnostic work-up is similar to that in open surgery. Three trocars are sufficient, and a fourth may be helpful. Dissection encompasses the entire aganglionic segment and is extended orally to normal bowel.. After complete dissection down to the pelvic floor the bowel is everted transanally, resected in due length and the coloanal anastomosis sutured from outside. Since 1996 four children out of nine (age 11 weeks - 18 years) have been operated laparoscopically at our institution. -

RESULTS

There were no intraoperative complications. Recovery time is impressively rapid. Oral intake may be begun on the first postoperative day and physical activity is rapidly restored. There are however problems typical to this method: anastomotic leakage, stricture formation, and the necessity of continuing dilation. -

CONCLUSIONS

The feasibility of laparoscopic colorectal resections of any extent is unquestionable. Benefits for the patient seem evident. Prospective randomized studies to provide a higher level of evidence for the benefit of laparoscopy as compared to open technique are difficult to perform due to the small number of patients.