CAO Guo qing,TANG Shao tao,YANG Ying et al..The clinical analysis of laparoscopic transanal puuthrough operation for rectosigmoild Hirschsprung disease (122 cases report).[J].Journal of Clinical Pediatric Surgery,,10():0.
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The clinical analysis of laparoscopic transanal puuthrough operation for rectosigmoild Hirschsprung disease (122 cases report).

Journal of Clinical Pediatric Surgery[ISSN:1671-6353/CN:43-1380/R] volume: 第10卷 Number: 2011 01 Page: 0 Column: Date of publication: 2011-02-28
Author(s):
CAO Guoqing;  TANG Shaotao;  YANG Ying et al.
Department of Pediatric surgery,Vnion Hospital, Tongji Medical College, Huaahong Vniversity of Science and Technology, Wuhan, Hubei Province 430022, China
Keywords:
Laparoscopes; Hirschsprung disease; Therapy
Abstract:
ObjectiveTo report early and late outcomes of laparoscopic transanal pullthrough leaving a short rectal sleeve for rectosigmoid Hirschsprung disease.Methods Laparoscopicassisted transanal pullthrough was performed using 3 or 4 Trocars. The ganglionic and aganglionic segments were initially identified by seromuscular biopsies obtained laparoscopically. Then removed pathological segments by laparoscopicassisted transanal pullthrough. However, we dissected with a long rectal seromuscular sleeve but left a short rectal seromuscular sleeve with the posterior sleeve Vshaped resected.Results122 rectosigmoid Hirschsprung disease patients(ages ranged from 15 days to 12 years old) treated through laparoscopic transanal pullthrough from 2001 to 2010.The median operating time was 125 minutes. There were no perioperative deaths and conversion to open surgery was required in 2 patients. Blood loss during the surgery was about 25ml. Intraoperative complications included twist of neorectum in 1 patient(0.8%) ,bleeding in 3 patients(2.5%).Early postoperative complications consisted of perianal excoriation in 12 patients(9.8%), anastomotic leak in 2 patients(1.6%) and 1 of which required colostomy, enterocolitis occurred in 3 patients(2.5%) and 5 occurred stricture(41%),no sphincter spasm or cuff abscess occurred. Late postoperative complications contained perianal excoriation in 7 patients(5.7%), adhesive bowel obstruction in 2 patients(1.6%), anal stenosis in 3 patients(2.5%),recurrent constipation in 2 patients(1.6%), enterocolitis occurred in 5 patients(4.1%) and no urinary incontinence occurred.The mean hospital stay was 10 days (range 7~15 days). Followup ranging from 3 to 8 years was obtained in 101 patients, defecations were 2 to 12 a day when 2 weeks after operation, 3 months later, defecations were 2 to 5 a day, fecal incontinence occurred in 5 patients (4.1%). Conclusions Laparoscopic transanal pullthrough with a long rectal seromuscular sleeve dissection but a short rectal seromuscular sleeve anastomosis is a safe and effective procedure for Hirschsprung disease.

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Memo

作者单位：华中科技大学附属协和医院小儿外科（武汉市，430022），通讯作者：汤绍涛，Email:tshaotao83@yahoo.com.cn

Last Update: 2011-02-28