Laparoscopic Anterior Rectosigmoidectomy with the Swenson's Procedure

Abstract

ABSTRACT

This article reports on the surgical procedure in anterior rectosigmoidectomy by laparoscopic approach. We have experience with 10 children. In all of these cases, resection was done according to the pull-through procedure of Swenson with preanal anastomosis of the bowel. In contrast to the Swenson procedure, the sigmoid colon was pulled through by invagination of the colon so that the bowel does not have to be severed intraperitoneally. This leads to a reduction of the operating time and prevents contamination of the abdominal cavity with bowel contents. Several techniques are applied for skeletization of the colon and sigmoid colon (diathermy, endoclips, laser, ligature). The pelvic floor is opened and the rectum is exposed up to 2 cm above the anal sphincter. Invagination of the proximal bowel is then carried out through the rectum and the anus. The exposed bowel is severed directly preanally and anastomosed in a single layer with interrupted sutures. We have performed this procedure 10 times. In 6 cases, the postoperative course was without complications. One child had a leakage of the suture line with abscess formation. The abscess was drained percutaneously. Three children had stenoses and 1 had a bleeding ulcer. Two of the stenoses were removed by bouginage and 1 by transanal endoscopic laser resection. One child suffered from an colostomy that was also laparoscopically resected during the same session. A transfer to open laparatomy was not necessary in any of the cases. Time of follow-up is 4 years.