title: Outcome of laparoscopic modified Duhamel procedure with Z-shaped anastomosis for Hirschsprung's disease.
abstract: BACKGROUND
  Several laparoscopic Duhamel-type procedures for Hirschsprung's disease (HD) have been reported, but laparoscopic, Z-shaped, colorectal, side-to-side anastomosis has not been described. Z-shaped anastomosis has been used as the treatment of choice for HD at our clinic for a long time. A laparoscopic approach was adopted to perform this Z-shaped anastomosis in 2001. We describe herein our experiences with laparoscopic Z-shaped anastomosis and evaluate the clinical outcomes.
  
  
  METHODS
  Between 2001 and 2010, 26 children with rectosigmoid HD underwent a laparoscopic modified Duhamel procedure comprising Z-shaped anastomosis. Mean age at operation was 17.2 months. Mean weight was 8.7 kg. No children had a colostomy. Seven children had trisomy 21 and one had Klinefelter syndrome. Laparoscopic modified Duhamel procedure was performed using three 5-mm trocars. Intra- and postoperative complications and functional outcomes were evaluated. Patients with trisomy 21 were excluded from the functional evaluation.
  
  
  RESULTS
  The operation was completed laparoscopically for 25 of the 26 patients, with only one patient requiring conversion to an open procedure because of injury to the ureter. Mean operating time was 296 min. In one case, a minor leak was observed. No infections or related complications were observed. Mean follow-up period was 50.4 months. Sudden death secondary to rotaviral enterocolitis occurred 8 months postoperatively in one case. Twenty-one of the 25 patients (84%) showed episodes of constipation during the early follow-up period, and one child required late myectomy due to sphincter achalasia. As the child grew older, the need for medication was diminished. Of the 14 patients over 4 years old, excluding those patients with trisomy 21, all achieved normal defecation without incontinence.
  
  
  CONCLUSIONS
  Our series revealed that all patients over 4 years old who underwent laparoscopic Z-shaped colorectal anastomosis achieved normal defecation without fecal incontinence. Laparoscopic Z-shaped colorectal anastomosis for HD appears feasible and safe to perform with good results.
authors: Department of Pediatric Surgery, Shizuoka Children's Hospital, 860 Urushiyama, Aoi-ku, Shizuoka, 420-8660, Japan. urushi@sch.pref.shizuoka.jp
authors: Naoto
authors: N
authors: Urushihara
authors: Koji
authors: K
authors: Fukumoto
authors: Hiroaki
authors: H
authors: Fukuzawa
authors: Akihide
authors: A
authors: Sugiyama
authors: Kentaro
authors: K
authors: Watanabe
authors: Maki
authors: M
authors: Mitsunaga
authors: Hiromu
authors: H
authors: Miyake
authors: Junich
authors: J
authors: Kusafuka
authors: Takeshi
authors: T
authors: Aoba
mesh_terms: D001003:Anal Canal / Q000601:surgery*; D000714:Anastomosis, Surgical / Q000379:methods; D002648:Child; D002675:Child, Preschool; D012809:Colon, Sigmoid / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D006627:Hirschsprung Disease / Q000601:surgery*; D006801:Humans; D007223:Infant; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay; D008297:Male; D016896:Treatment Outcome