title: One-stage laparoscopy-assisted endorectal pull-through for late presented Hirschsprung's disease-Case series.
abstract: BACKGROUND
  Children with late-presenting Hirschsprung's disease (HD) are classically treated by a staged operation with enterostomy. An alternative may be one-stage laparoscopy-assisted endorectal pull-through, which has cosmetic advantages. This case-series report describes the outcomes of children with late-presenting HD who underwent this procedure.
  
  
  METHODS
  Eight older (>3 years) children (five males, three females) underwent one-stage laparoscopy-assisted endorectal pull-through in 2010-2012. A retrospective review revealed their median age was 9.9 (range, 3.4-14) years. The transitional zone was rectosigmoid junction in 4 patients, and was rectum in 4 patients. For bowel preparation, five patients required rectal irrigation under general anesthesia. The median operating time was 263min. There were no intraoperative or early post-operative complications. Patients started a diet a median of 5 days after the operation and were discharged a median of 11.5 days. During the median follow-up period of 37 months, seven (87.5%) had acquired voluntary bowel movements and 12.5% had grade 1 soiling. However, five (62.5%) of the patients still had constipation. The constipation was manageable with diet or laxatives in four patients but one patient continued to require regular enemas.
  
  
  CONCLUSIONS
  One-stage laparoscopy-assisted endorectal pull-through in late-presenting HD was feasible, even in patients with large fecaloma with obstruction. Rectal irrigation under general anesthesia and the use of laparoscopy and a bipolar coagulator help to overcome the technical difficulties of this procedure.
  
  
  CONCLUSIONS
  One-stage laparoscopy-assisted endorectal pull-through in children with late-presenting short segment HD is feasible and safe.
authors.affiliation: Department of Surgery, Dong-A University College of Medicine, Dong-A University Hospital, Republic of Korea.
authors.forename: So Hyun
authors.initials: SH
authors.lastname: Nam
authors.affiliation: Division of Surgery, Konkuk University Medical Center, Repulic of Korea.
authors.forename: Min Jeong
authors.initials: MJ
authors.lastname: Cho
authors.affiliation: Department of Pediatric Surgery, University of Ulsan College of Medicine and Asan Medical Center, Republic of Korea. Electronic address: kimdy@amc.seoul.kr.
authors.forename: Dae Yeon
authors.initials: DY
authors.lastname: Kim
keywords: Children; Hirschsprung’s disease; Laparoscopy