[Minimally invasive surgery in the treatment of Hirschsprung disease]

Transanal one-stage endorectal pull-through for Hirschsprung's disease: a comparison with the staged procedures

Transanal one-stage endorectal pull-through (TOSEPT) has been presented as the most recent progression in treatment of Hirschsprung's disease (HD), which may be able to replace various previous techniques. This prospective study was designed to compare the efficacy and probable complications of the commonly used open surgery with those of TOSEPT technique in management of HD. Forty-two children (35 boys and 7 girls) between 3 days and 12 years of age underwent surgical treatment for HD-all after being diagnosed by barium enema over an 18-month period. In a manner of systematic random selection, 21 patients were operated by TOSEPT and the other 21 by Swenson procedures. All patients were followed-up at least for 12 months after hospital discharge. The necessary data containing age, sex, length of the resected aganglionic segment, intraoperative details, duration of hospital stay and postoperative functional results or complications were collected during hospitalization and follow-up period. There was no significant difference in age at the first operation, sex distribution and length of resected bowel between the two groups. Rate of postoperative complications were significantly higher in Swenson procedure group (P < 0.01). Narcotics were needed in all patients of Swenson procedure group but only in two patients operated by TOSEPT also required laparotomy (P < 0.001). The hospitalization period of TOSEPT group was also less than that of Swenson group (P < 0.001). The total cost of treatment by Swenson procedure is considerably higher than by TOSEPT. TOSEPT can significantly diminish postoperative pain, surgical complications, hospital stay and cost burden caused by Hirschsprung's disease. Besides, this procedure is cosmetically preferable because no visible scar remains.

Chirurgie cœlioscopique chez l'enfant

In the last two decades, laparoscopy surgery has been progressively adopted to children. Cardiorespiratory changes induced have been understood and controlled. Abdominal and urological surgery have widely benefited from this technique. Immediate postoperative period is simpler. The risk of small bowel obstruction by bands and adhesions is limited. Nevertheless, laparoscopy is not indicated for all pathologies. In neonatal surgery, more studies are necessary. Maybe the future is robotic surgery.