Single-Incision Laparoscopic Endorectal Pull-Through (SILEP) for Hirschsprung Disease

Background Over the last 15 years, the laparoscopic-assisted endorectal pull-through procedure first described by Georgeson has become the standard treatment for Hirschsprung disease in many centers around the world We report the first six patients who were operated using a single-incision endosurgical approach Methods Six infants (one female) diagnosed with Hirschsprung disease underwent laparoscopic endorectal pull-through via a single 1 cm horizontal skin incision in the umbilicus Firstly, laparoscopic seromuscular leveling biopsies of the rectum and sigmoid were obtained The affected rectosigmoid colon and rectum was then mobilized distally beyond the peritoneal reflection, facilitating the subsequent perineal dissection, pull-through, and coloanal anastomosis Operative variables were compared between single-incision and conventional laparoscopic endorectal pull-through Results The patients' average age and weight was 28 days and 3 8 kg, respectively Operative time ranged from 90 to 220 mm, with a mean estimated blood loss of 3 7 ml There were no intraoperative complications Postoperatively, all six patients recovered uneventfully and were discharged home on full feeds after a median of 7 days On follow-up, the patients had virtually no appreciable scar, were feeding well, stooling, and gaining weight appropriately The results were similar to those of conventional laparoscopic endorectal pull-through Conclusion Although technically challenging, laparoscopic-assisted endorectal pull-through in infants with Hirschsprung disease can be performed safely through a single umbilical incision with good postoperative results and excellent cosmesis