title: Laparoscopic-assisted transanal pull-through for Hirschsprung's disease: Comparison between partial and near total laparoscopic mobilization of rectum.
abstract: BACKGROUND
  Transanal pull-through with laparoscopic assistance is gaining popularity. How much rectal dissection to do laparoscopically and how much transanally is not clear. Laparoscopic rectal mobilization is akin to open pelvic dissection of Swenson's operation - the most physiological procedure. Through this comparative study, we aim to evolve a technique that maximizes the benefits of Swenson's technique and minimizes the problems of a transanal procedure.
  
  
  METHODS
  Twenty patients (19 boys and one girl, newborn to 6 years) with Hirschsprung's disease (HD) were randomized for laparoscopic-assisted transanal pull-through (LATAPT) either by near complete (Group A) or partial (Group B) laparoscopic mobilization of rectum. Patients were followed up for at least 3 months. Demographic profile; operative details (time taken, blood loss, operative difficulty, and complications); postoperative course (duration of urinary catheter, oral feeding, and hospital stay); and follow-up stooling pattern, consistency, and continence were compared in the two groups.
  
  
  RESULTS
  The time taken for laparoscopic mobilization was marginally higher in group A, but the time taken for transanal dissection in this group was significantly less than in group B. All other comparisons showed no significant difference in the two groups. Stool frequency and continence improved with time in both groups.
  
  
  CONCLUSIONS
  Extent of laparoscopic mobilization of rectum does not appear to be a factor deciding the outcomes. No recommendations could be made in view of the small number of cases. However, it shows that laparoscopic assistance can be used to maximize the benefits of Swenson type of operation and a transanal pull-through.
authors.affiliation: Senior Resident of Paediatric Surgery, Maulana Azad Medical College, New Delhi, India ; Senior Resident at Chacha Nehru Bal Chikitsalaya, New Delhi, India.
authors.forename: Mohit Kumar
authors.initials: MK
authors.lastname: Mathur
authors.affiliation: Senior Resident of Paediatric Surgery, Maulana Azad Medical College, New Delhi, India.
authors.forename: Satish Kumar
authors.initials: SK
authors.lastname: Aggarwal
authors.affiliation: Senior Resident of Paediatric Surgery, Maulana Azad Medical College, New Delhi, India.
authors.forename: Simmi K
authors.initials: SK
authors.lastname: Ratan
authors.affiliation: Senior Resident of Paediatric Surgery, Maulana Azad Medical College, New Delhi, India.
authors.forename: Shandip Kumar
authors.initials: SK
authors.lastname: Sinha
keywords: Endorectal pull-through; Hirschsprung's; laparoscopy; transanal
references.citation: J Pediatr Surg. 2003 Oct;38(10):1440-3
references.pmid: 14577065
references.citation: J Pediatr Surg. 2007 Jan;42(1):36-9; discussion 39-40
references.pmid: 17208538
references.citation: J Laparoendosc Adv Surg Tech A. 2005 Feb;15(1):75-9
references.pmid: 15772484
references.citation: J Pediatr Surg. 2007 Jan;42(1):41-7; discussion 47
references.pmid: 17208539
references.citation: J Pediatr Surg. 2004 Mar;39(3):345-51; discussion 345-51
references.pmid: 15017550
references.citation: Ann Surg. 1999 May;229(5):678-82; discussion 682-3
references.pmid: 10235526
references.citation: Eur J Pediatr Surg. 2006 Oct;16(5):312-7
references.pmid: 17160774
references.citation: J Pediatr Surg. 1998 Aug;33(8):1283-6
references.pmid: 9722005
references.citation: J Laparoendosc Adv Surg Tech A. 2011 Jan-Feb;21(1):81-3
references.pmid: 21314566
references.citation: J Laparoendosc Adv Surg Tech A. 2007 Dec;17(6):809-12
references.pmid: 18158815
references.citation: J Pediatr Surg. 1995 Jul;30(7):1017-21; discussion 1021-2
references.pmid: 7472924
references.citation: Surgery. 1948 Aug;24(2):212-20
references.pmid: 18872852
references.citation: Semin Pediatr Surg. 2010 May;19(2):96-106
references.pmid: 20307846
references.citation: J Pediatr Surg. 2003 Oct;38(10):1434-9
references.pmid: 14577064
references.citation: Scand J Surg. 2011;100(4):243-9
references.pmid: 22182845