title: 10 years of experience with laparoscopic-assisted endorectal Soave pull-through procedure for Hirschsprung's disease in China.
abstract: OBJECTIVE
  To report early and late results of laparoscopic-assisted endorectal Soave pull-through (LAEPT) with a short and V-shaped partial resection muscular cuff for Hirschsprung's disease (HD) over a 10-year period.
  
  
  METHODS
  The clinical courses of 218 patients who underwent modified LAEPT for HD were reviewed. LAEPT was described by the Georgeson technique. The main modifications included less dissection of the bottom of the pelvis, rectal mucosa dissection with a long cuff, coloanal anastomosis with a short cuff, and a V-shaped partial resection in the posterior wall of the muscular cuff.
  
  
  RESULTS
  From September 1999 to July 2009, 218 patients were operated on by the same surgeon. Ages ranged from 15 days to 12 years old. The aganglionic segment was located in the rectum or sigmoid colon in 176 patients, in the left colon in 38 children, and in the transverse colon in 4 patients. The median operating time was 176 minutes. Conversion to open surgery was required in 2 patients. Bleeding of the left iliac vein occurred in 1 patient, and a 180° twist of the neorectum occurred in 2 cases. Median first bowel movement time was 23 hours, and median postoperative hospital stay was 10.4 days. Median daily defecation frequency was 4.6 within 2 weeks and 2.3 at 3 months postoperatively. The immediate postoperative complications included intestine herniation from the trocar site in 2 patients, perianal excoriation in 32 patients, and anastomotic leakage in 3 patients. Follow-up ranging from 6 to 120 months was obtained for 182 patients. Late postoperative complications included postoperative adhesive bowel obstruction (1.1%), enterocolitis (7.7%), anasomostic stenosis (2.2%), constipation (1.6%), and soiling (3.6%). Eighty-seven percent had excellent and good bowel function.
  
  
  CONCLUSIONS
  LAEPT with a short muscular cuff with a V-shaped partial resection in the posterior wall is a safe and effective procedure for HD.
authors.affiliation: Department of Pediatric Surgery, Union Hospital of Huazhong University of Science and Technology, Wuhan, China. tshaotao83@126.com
authors.forename: Shao-tao
authors.initials: ST
authors.lastname: Tang
authors.forename: Guo-bin
authors.initials: GB
authors.lastname: Wang
authors.forename: Guo-qing
authors.initials: GQ
authors.lastname: Cao
authors.forename: Yong
authors.initials: Y
authors.lastname: Wang
authors.forename: Yong-zhong
authors.initials: YZ
authors.lastname: Mao
authors.forename: Shi-wang
authors.initials: SW
authors.lastname: Li
authors.forename: Shuai
authors.initials: S
authors.lastname: Li
authors.forename: Ying
authors.initials: Y
authors.lastname: Yang
authors.forename: Jun
authors.initials: J
authors.lastname: Yang
authors.forename: Li
authors.initials: L
authors.lastname: Yang
mesh_terms: D002648:Child; D002675:Child, Preschool; D002681:China; D013505:Digestive System Surgical Procedures / Q000379:methods*; D005260:Female; D006627:Hirschsprung Disease / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D011183:Postoperative Complications; D020127:Recovery of Function; D013997:Time Factors; D016896:Treatment Outcome