New laparoscopic surgical technique for Hirschsprung's disease: The prolapsing technique

Laparoscopic surgery for the definitive treatment of Hirschsprung's disease was successfully done in a 1-year-old boy. The authors report a new technique, which seems to be suitable for the short segment aganglionosis when performing laparoscopic Duhamel procedure in young infants. The technique consists of two different approaches. The rectum is hooked and secured to the abdominal wall with a rubber vessel tape to obtain a good operative view and working space in the small pelvic cavity. After dissection of the lower rectum from its attachment, a rectal prolapse is created with a laparoscopic assistance. The rectum is then divided out of the anal canal. Each stump is closed and returned into the abdomen. A proximal stump of the rectum is pulled through and a colo-anal anastomosis is made by Duhamel procedure. A septum between aganglionic pouch and a colon is divided by endo- GIA(TM). Dividing the lower rectum in the small pelvic cavity is one of the most difficult procedures of the laparoscopic technique. The technique we applied is feasible and seems to be useful for not only Hirschsprung's disease but also low anterior resection.