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. Patients and 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, ge...