Definitive Treatment for Extended Hirschsprung Disease or Total Colonic Form: Laparoscopic Pull-through Technique

Background: Between December 1990 and January 2002, seven laparoscopic Duhamel pull-through procedures for the extended form of Hirschsprung disease or total aganglionosis were performed in our department. Methods: The aim of this study was to show that even in the extended form of Hirschsprung disease, the laparoscopic approach is possible and total colectomy feasible. The procedure we used has been described in a previous article. We used one camera port and three working ports. The sigmoid, transverse, and right colon until the last ileal cove was mobilized laparoscopically. A standard posterior ileoanal anastomosis was performed, and a GIA stapler was used for the anterior anastomosis. Results: Seven patients underwent laparoscopic surgery: five with the total colonic form of Hirschsprung disease, one with the rectosigmoid form but with a short bowel and resected colon due to a volvulus, and one with the transverse variant in whom the Deloyer technique was used for the pull-through. Five infants were in need of total parenteral nutrition (TPN) for an average of 1.8 months (range, 1-3) from diversion until the definitive procedure. Only one had no TPN. Postoperatively, three complications occurred: one wound infection, one hectic fever, and one ileal perforation with peritonitis. The clinical results were good, with no soiling or stool incontinence, and no constipation. Conclusion: The laparoscopic procedure for total aganglionosis or extended form of Hirschsprung disease is safe, feasible, and reproducible.