Laparoscopy-assisted pull-through for Hirschsprung's disease in a 3 year old boy

Posted by Jafrul Hannan on Wed, Oct 21, 2009  
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A 3 year old boy presented with h/o constipation since birth. He was delivered by normal vaginal delivery at home. He did not pass any meconium for the first two days of his life and the parents then used betel leaf root ( pan-bota) to make him defecate. Since then they had to use the same remedy from time to time. At presentation the abdomen was hugely distended, tympanitic. Rectum was empty and upon withdrawal of finger gushes of feces and flatus came out. Barium enema failed to show the typical pattern, but there was hugely distended distal colon and retained barium in 24 hours film. The boy was prepared for operation with regular enema for two weeks and then admitted. Kept for NPO for two days and taken to the OT. Under general anesthesia the laparoscope was introduced through the supra-umbilical port and the typical Hirschsprung's pattern was found in the recto-sigmoid. Two more ports were inserted one on each side of umbilicus. The abdominal part of dissection was done laparoscopically. Then the trans-anal dissection performed and once entered the peritoneal cavity the dissected colon was pulled down and the diseased part along with transitional zone and dilated part were removed. Then the colo-anal anastomosis performed. Patient was kept NPO for 48 hours then allowed and tolerated feeds and discharged on 4th POD with 3-4 bowel movements a day.

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