Minimal invasive approach to paediatric colorectal surgery

Hirschsprung’s disease (HSCR), anorectal malformations (ARM), and inflammatory bowel diseases (IBD) are the main paediatric colorectal diseases treated with minimally invasive surgery (MIS). The authors describe their experience and track the historical evolution of MIS in these entities. A non-systematic review is performed to determine the incidence and type of complications reported  to date. The literature research was performed using PubMed database. The personal series included all patients with HSCR, ARM, or IBD who underwent MIS from 2006 to 2018. Demographic data, type of surgical procedure, complications and long-term outcomes were analysed. The literature research showed an increasing use of MIS for HSCR over the years, with less post-operative pain, shorter hospital stay, and improved  cosmesis compared to open surgery; without differences in complication rates and outcomes. Only high ARMs are considered for managment by MIS; with laparoscopy, however being a risk factor  for the development of  a remnant of the original fistula (ROOF) and rectal mucosal prolapse. MIS procedures have shown excellent results in adults affected by IBD, whereas only a few studies have been published on paediatric patients. We have performed 269 laparoscopic colorectal procedures; half of them for HSCR with 3 major complications (2.3%). Twenty-one laparoscopic procedures for ARM were associated with 1 anastomotic stricture and 1 ROOF. One hundred and fourteen laparoscopic procedures were performed for IBD, with 13.1% complication. Minimally invasive surgery provides similar results when compared to total trans-anal approach and open surgery in HSCR. Similarly, its use in ARM and IBD seems to be safe and beneficial, provided that selected cases are performed by highly experienced surgeons.