Primary laparoscopic pull-through procedure for Hirschprung disease at a low resource setting: Experience and early results

Objective: To evaluate the feasibility of performing the single stage primary laparoscopic pullthrough (PLPP) surgery for Hirschprung disease (HD) to avoid the morbidity associated with traditional staged multiple surgery.

Method: PLPP was performed on 12 patients with histologically diagnosed, uncomplicated HD below the age of 4 years since April 2010. Adequate bowel preparation was achieved prior to surgery. Four-port video laparoscopy was performed. The transition zone was identified with biopsies and confirmed with frozen section. Colon and rectum were mobilized close to its wall up to the pelvic floor. Rectal prolapse was induced intussuceptically and the rectum transected 2cm above the dentate line. Colon was pulled down through anus and divided at biopsy site level. Colo-anal anastomosis was performed over a rectal tube.

Results: A noteworthy improvement of bowel habits and general well being was expressed by parents during follow-up assessment. Early results from our study, as well as the long-midterm results from elsewhere in the world, suggest that the PLPP is superior to the traditional staged procedure.

Conclusion: PLPP is a better, safer and more effective approach of treating HD.

(Key words: Hirschprung disease; primary laparoscopic pullthrough)

DOI: http://dx.doi.org/10.4038/sljch.v41i2.4395