title: Factors affected by surgical technique when treating total colonic aganglionosis: laparoscopy-assisted versus open surgery.
abstract: BACKGROUND
  We compared laparoscopy-assisted Duhamel (Lap-D) with open surgery (Duhamel or Soave = D/S) for treating total colonic aganglionosis (TCA) in children to establish what factors may affect outcome.
  
  
  METHODS
  Fourteen TCA cases treated between 1990 and 2010 were reviewed. Open D/S (O-D/S) through a vertical midline abdominal incision was routine from 1990 to 2005, whereupon Lap-D became routine. Lap-D involves laparoscopic colon resection, ileostomy take-down, and ileum pull-through through an additional Pfannenstiel incision. We compared pre-operative nutrition, operating time, intraoperative blood loss, duration until oral challenge, postoperative analgesic usage, incidence of enterocolitis, early complications that arose within 30 days of surgery, and late complications, and wound cosmesis 1 year postoperatively (Grade-1: unacceptable, Grade-2: passable, Grade-3: excellent).
  
  
  RESULTS
  Six had O-D/S (2D, 4S) and eight had Lap-D. Differences in patient demographics, mean ages/weights at surgery, average length of the aganglionic segment from the terminal ileum, operating time, and time taken for oral challenge were all not significant, full feeding took longer in O-D/S (6.7 vs. 5.9 days). Preoperative central vein intravenous hyperalimentation was required for one case in O-D/S and two cases in Lap-D. These three required hospitalization for at least 30 days postoperatively and parenteral nutrition after discharge. Although there were no intraoperative complications in either group, there was one case of transient ileus in O-D/S that resolved conservatively. Cosmesis was significantly better in Lap-D (O-D/S = 1.2; Lap-D = 2.1; p < 0.05).
  
  
  CONCLUSIONS
  Cosmesis was the only factor that was significantly different between Lap-D and O-D/S; all other factors were similar.
authors.affiliation: Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, Japan. go1993@hotmail.co.jp
authors.forename: Go
authors.initials: G
authors.lastname: Miyano
authors.forename: Takanori
authors.initials: T
authors.lastname: Ochi
authors.forename: Geoffrey J
authors.initials: GJ
authors.lastname: Lane
authors.forename: Tadaharu
authors.initials: T
authors.lastname: Okazaki
authors.forename: Atsuyuki
authors.initials: A
authors.lastname: Yamataka
mesh_terms: D013505:Digestive System Surgical Procedures / Q000379:methods*; D006627:Hirschsprung Disease / Q000601:surgery*; D006801:Humans; D007223:Infant; D010535:Laparoscopy; D017060:Patient Satisfaction; D012189:Retrospective Studies; D016896:Treatment Outcome