title: The preliminary study of modified Swenson procedure in Hirschsprung disease.
abstract: OBJECTIVE
  We have been using the Swenson procedure for more than 3 decades for Hirschsprung disease (HD). Recently, we modified this procedure, leaving the anterior wall below the peritoneal reflection undissected (mSwen). In 2000, we introduced mSwen with laparoscopic guidance (LapmSwen). We hypothesized that (1) omitting anterior wall dissection would not affect postoperative anorectal function, and (2) reduced dissection with better visualization via laparoscopy would reduce operative risks.
  
  
  METHODS
  Charts of 89 patients with Hirschsprung disease operated on between 1990 through 2005 were retrospectively reviewed. Comparisons between Swen and mSwen, as well as between mSwen and LapmSwen, were analyzed in terms of operating time, blood loss, and complications.
  
  
  RESULTS
  Mean operating times (minutes) were 312 for Swen, 284 for mSwen (P = .152), and 302 for LapmSwen ( mSwen, P = .218). Mean blood loss (mL) were 64.8 for Swen, 60.3 for mSwen (P = .669), and 8.7 for LapmSwen (as compared to mSwen, P = .001). We noted leakage in 7 Swen, 2 mSwen, and no LapmSwen patients. There were no significant differences between Swen and mSwen, or between mSwen and LapmSwen, in the incidence of enterocolitis, constipation, and soiling.
  
  
  CONCLUSIONS
  LapmSwen appeared to be comparable to the standard and modified Swenson procedures in most measures. Operative blood loss may be reduced in the LapmSwen approach.
authors.affiliation: Kobe Children's Hospital, Department of Pediatric Surgery, Kobe, Hyogo 654-0081, Japan. yokoi_kch@hp.pref.hyogo.jp
authors.forename: Akiko
authors.initials: A
authors.lastname: Yokoi
authors.forename: Shiiki
authors.initials: S
authors.lastname: Satoh
authors.forename: Shigeru
authors.initials: S
authors.lastname: Takamizawa
authors.forename: Toshihiro
authors.initials: T
authors.lastname: Muraji
authors.forename: Chikara
authors.initials: C
authors.lastname: Tsugawa
authors.forename: Eiji
authors.initials: E
authors.lastname: Nishijima
mesh_terms: D016063:Blood Loss, Surgical; D003125:Colostomy; D013505:Digestive System Surgical Procedures / Q000379:methods*; D005260:Female; D006627:Hirschsprung Disease / Q000601:surgery*; D006801:Humans; D007223:Infant; D010535:Laparoscopy; D008297:Male; D011183:Postoperative Complications; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D013997:Time Factors; D016896:Treatment Outcome