ABSTRACT
Laparoscopy-assisted endorectal pull-through for Hirschsprung’s disease is being performed in increasing numbers of the neonatal record.24-26 The procedure is performed using three small abdominal ports. The transition zone is identified by seromuscular biopsies obtained laparoscopically. In patients with a rectosigmoid colon transition zone, the intra-abdominal portion of the aganglionic bowel is devascularized using a hook electrocautery. In patients with the longer segments of aganglionic colon, a pedicle preserving the marginal artery is fashioned as far proximal as necessary to bring the colon pedicle down without tension to form the neorectum. The rectal mobilization is performed transanally using an endorectal sleeve technique. The anastomosis is performed transanally 0.5 cm above the dentate line. The early clinical outcomes after a one-stage laparoscopy-assisted endorectal pull-through have been reported in 80 patients aged 3 days to 96 months and appear to reduce perioperative complications and postoperative recovery time.25 Most of these patients were too young to evaluate fecal continence. However, the author’s impression is that fecal continence after this procedure is equivalent to that after procedures performed in an open fashion. Successful techniques for performing laparoscopy-assisted Duhamel and Swenson pull-through procedures have also been reported in neonates.
