title: Clinical outcome of laparoscopically assisted endorectal pull-through in Hirschsprung's disease: comparison of abdominal and perineal approaches.
abstract: OBJECTIVE
  Laparoscopically assisted endorectal pull-through (EPT) via a perineal approach using a prolapsing technique (PA) for Hirschsprung's disease (HD) has been reported. However, the clinical outcome after this approach has not been reported. The purpose of this study was to compare the clinical outcome of PA and the conventional transabdominal approach (TA).
  
  
  METHODS
  In the period between 1990 and 2001, 20 cases of HD underwent EPT with TA (group O), and 21 underwent EPT with PA (group L). There was no difference in age and weight distribution between the 2 groups. Clinical outcome was assessed 3 years after surgery.
  
  
  RESULTS
  The operation time was comparable in the 2 groups (4.9 +/- 0.8 v 5.2 +/- 0.8 hr), whereas blood loss (98 +/- 52 v 36 +/- 30 mL) and postoperative complications requiring surgical intervention (26% v 0%) were significantly lower in group L. The incidence of postoperative enteritis (27% v 28%) and voluntary defecation (more than once every/2 days) were compatible in the 2 groups (70% v 87%). Soiling (small amount of involuntary stooling; >1 per month) was significantly less frequent in group L (45% v 14%).
  
  
  CONCLUSIONS
  Laparoscopically assisted ETP with PA is less invasive and can provide a better clinical outcome compared with TA in terms of postoperative soiling.
authors.affiliation: Department of Pediatric Surgery, Osaka Medical Center and Research Institute for Maternal and Child Health, Izumi, Japan.
authors.forename: A
authors.initials: A
authors.lastname: Kubota
authors.forename: H
authors.initials: H
authors.lastname: Kawahara
authors.forename: H
authors.initials: H
authors.lastname: Okuyama
authors.forename: T
authors.initials: T
authors.lastname: Oue
authors.forename: Y
authors.initials: Y
authors.lastname: Tazuke
authors.forename: A
authors.initials: A
authors.lastname: Okada
mesh_terms: D000005:Abdomen; D006627:Hirschsprung Disease / Q000601:surgery*; D006801:Humans; D007223:Infant; D010535:Laparoscopy / Q000379:methods*; D010502:Perineum; D012007:Rectum