title: Hybrid Single-Incision Laparoscopic Approaches for Endorectal Pull-Through in Hirschsprung's Disease.
abstract: BACKGROUND
  Transanal endorectal pull-through for Hirschsprung's disease (HD) is a relatively safe and feasible procedure in neonates and infants. However, overstretching on the anal sphincter and mesentery of the sigmoid colon might cause potential risk of impaired defecation function. Single-incision laparoscopic endorectal pull-through (SILEP) is technically feasible and safe in HD patients, offering a better cosmetic result. However, it is stressful for the surgeon in view of its low manipulability and poor visualization causing clashing of instruments, especially in older children or patients with long-segment aganglionosis. We developed an age- and type-appropriate technique of hybrid SILEP (H-SILEP) using a trocarless instrument via another abdominal stab incision to obtain further improvement of SILEP in selected HD patients.
  
  
  METHODS
  Between August 2010 and July 2013, 36 patients (24 boys and 12 girls, with a mean age of 3.9 months) with HD underwent H-SILEP. Patient age, gender, transitional zone, operative time, blood loss, and intraoperative and postoperative complications, as well as short- and long-term results, were assessed.
  
  
  RESULTS
  Ten patients had transitional zone in the rectum, 17 patients in the sigmoid colon, and 9 patients in the descending colon. Neither additional ports nor conversion to laparotomy was required in these 36 patients. The mean operative time was 116 minutes. There was no major intraoperative complication. Perianal excoriation was the main early postoperative complication, which occurred in 9 patients. No anastomotic leak occurred. Postoperative enterocolitis occurred in 2 patients. There was no recurrent constipation. Follow-up for 6 months to 3 years in all patients showed an excellent cosmetic result.
  
  
  CONCLUSIONS
  Our procedure is feasible and safe, and it is technically less challenging to perform H-SILEP in selected HD patients. Moreover, it is better to use additional instruments for ergonometric reasons.
authors.affiliation: Department of Pediatric Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology , Wuhan, China .
authors.forename: Tajammool Hussein
authors.initials: TH
authors.lastname: Aubdoollah
authors.affiliation: Department of Pediatric Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology , Wuhan, China .
authors.forename: Shao-Tao
authors.initials: ST
authors.lastname: Tang
authors.affiliation: Department of Pediatric Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology , Wuhan, China .
authors.forename: Li
authors.initials: L
authors.lastname: Yang
authors.affiliation: Department of Pediatric Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology , Wuhan, China .
authors.forename: Shuai
authors.initials: S
authors.lastname: Li
authors.affiliation: Department of Pediatric Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology , Wuhan, China .
authors.forename: Hai-Yan
authors.initials: HY
authors.lastname: Lei
authors.affiliation: Department of Pediatric Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology , Wuhan, China .
authors.forename: Xi
authors.initials: X
authors.lastname: Zhang
mesh_terms: D016063:Blood Loss, Surgical; D002675:Child, Preschool; D012809:Colon, Sigmoid / Q000601:surgery; D003248:Constipation / Q000209:etiology / Q000601:surgery; D013505:Digestive System Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006627:Hirschsprung Disease / Q000150:complications / Q000601:surgery*; D006801:Humans; D007223:Infant; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D008297:Male; D061646:Operative Time; D011184:Postoperative Period; D012007:Rectum / Q000601:surgery