Long-term outcomes of laparoscopic-assisted endorectal pull-through for long-segment Hirschsprung's disease

Objective To evaluate the long-term outcomes of laparoscopic-assisted endorectal pull-through (LAPT) for long-segment type Hirschsprung’s disease (HD). Methods From September 2001 to December 2009, a total of 65 patients with long-segment HD undergoing LAPT were recruited. There were 48 males and 17 females. And major postoperative complications, subsequent treatment, present bowel function and anal sphincter performance were analyzed. Results LAPT was all successfully performed. Twenty-six and 39 patients underwent primary operation (PP) and two-stage operation (SP) respectively. Early severe postoperative complications included anastomotic leakage (n=1) and twisted pull-through (n=1). And major mid-term complications were recurrent constipation due to residual intestine with dysplastic neuron (IND, n=4) or acquired aganglionosis (n=1). The incidence of postoperative enterocolitis was similar in both groups (PP: 15.4% vs SP: 10.3%). The incidence of reoperation was 26.9% in PP and 7.7% in SP. And that of redo pull-through was 19.2% and 2.6% respectively. Fifty-one patients(PP, n=19; SP, n=32)were followed-up for over 5 years. None developed fecal incontinence. However, soiling and constipation occurred in 3 (5.9%) and 2 (3.9%) respectively. The long-term anal functional outcomes of two groups were similar according to the Reding scoring system. For those with good bowel function, it was 73.7% in PP and 75.0% in SP. Among 51 patients, twenty-nine were evaluated with anorectal manometry and barium enema. All 29 patients had a negative rectoanal relaxation reflex. Among 5 patients with low anal resting pressure, 2 constipated ones with IND showed a marked dilatation of ileocecal junction and the remainder had barium or endorectal irrigation solution spilling during contrast enema or anorectal manometry. Conclusions Surgical patients with long-segment of HD via LAPT may achieve fair long-term bowel functions. And SP is recommended for neonates and infants with long-segment HD. Key words: Hirschsprung’s disease; Laparoscopes; Child