title: Extra-anal mucosectomy: laparascopic-assisted endorectal pull-through using a prolapsing technique.
abstract: OBJECTIVE
  The mucosectomy of the aganglionic rectal mucosa has been performed transabdominally in the Soave procedure. Recently, mucosectomy with transanal approach was reported both in the laparoscopic and the open surgical procedure. However, the operative view and working field are restricted because the dissection has to be done in the anal canal. The authors report an innovative approach, an extra-anal mucosectomy, to perform mucosectomy in the Soave procedure for Hirschspung's disease in combination with the laparoscopic-assisted prolapsing technique.
  
  
  METHODS
  Four patients underwent laparoscopic surgery for Hirschsprung's disease with extra-anal mucosectomy between 1995 and 1997. One 10-mm and 5-mm ports were used throughout the operation. The rectum was pulled out through the anal canal to create a rectal prolapse and was divided outside the anal canal. The mucosectomy was performed in the everted rectal mucosa outside the anal canal to the level of dentate line. The colon was sutured to the anal mucosa 2 mm above the dentate line. Mean operative time was 3 hours.
  
  
  RESULTS
  The present technique made the whole mucosectomy possible under direct observation.
  
  
  CONCLUSIONS
  The extra-anal mucosectomy in conjunction with a laparoscopic-assisted prolapsing technique seems to be a safe and reliable modality in the surgical treatment of Hirschsprung's disease.
authors.affiliation: Department of Surgery, Keio University School of Medicine, Tokyo, Japan.
authors.forename: Y
authors.initials: Y
authors.lastname: Morikawa
authors.forename: K
authors.initials: K
authors.lastname: Hoshino
authors.forename: K
authors.initials: K
authors.lastname: Matsumura
authors.forename: S
authors.initials: S
authors.lastname: Yoshioka
authors.forename: J
authors.initials: J
authors.lastname: Yokoyama
authors.forename: M
authors.initials: M
authors.lastname: Kitajima
mesh_terms: D001003:Anal Canal / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006627:Hirschsprung Disease / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D007223:Infant; D007413:Intestinal Mucosa / Q000601:surgery*; D020706:Laparoscopes; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D012007:Rectum / Q000601:surgery*; D016896:Treatment Outcome