Abstract
Primary laparoscopic endorectal pull-through has been described by Georgeson as the video-assisted version of the Soave procedure for the treatment of aganglionosis.
We use that technique with the variant of dividing just the inferior mesenteric vessels to mobilize the left side of the colon. This maneuver preserves the blood supply from the largest vessels (left colic and sigmoid arteries) and allows complete section of the mesosigmoid along an avascular plane.
We dissect the pelvic rectum as usual by endorectal mucosectomy from below, starting about 0.5 cm above the pectinate line. The following section of the prolapsed muscular cuff together with the superior hemorrhoidal vessels connects the two dissection planes and allows the completely mobilized colon to be pulled down loosely transanally until the level of normal bowel innervation. The colo-anal anastomosis is always performed by hand.
This technique has been used in 17 patients ages 25 days to 12 years. In every case, adequate mobilization was achieved. No intraoperative problem required conversion to open surgery.
The procedure allows quick and neat mobilization of the left colon and the best blood supply to the pulled-through bowel.
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