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Laparoscopic-assistance for Hirschsprung disease (HD) pullthrough procedures has increased in popularity. This change has been associated in the UK, for example, with a shift from the Duhamel procedure, which had been performed most frequently, to an endorectal pull-through (ERPT) procedure that is being practiced more widely [1]. The concept of the transanal only approach was put forth by Langer and de la Torre, but this was using a Soave-like dissection, a problem noted by Swenson himself who originated this concept with the original repair for HD [2]. The use of the Swenson-like technique for ERPT has been popularized by Levitt and colleagues [3], who reported a series of 67 patients in 2013. The advantages of this approach are its simplicity, preservation of the pelvic nerves, and avoidance of the obstructing muscle cuff that may occur after the Soave-Boley procedure [4]. The procedure can be undertaken as a purely transanal operation for cases in which rectosigmoid aganglionosis is obvious from the contrast study, but initial laparoscopic colonic mobilization and biopsy are preferred in most cases. |
