Retrospective Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Aug 7, 2015; 21(29): 8903-8911
Published online Aug 7, 2015. doi: 10.3748/wjg.v21.i29.8903
Clinical outcomes and ergonomics analysis of three laparoscopic techniques for Hirschsprung's disease
Tajammool Hussein Aubdoollah, Kang Li, Xi Zhang, Shuai Li, Li Yang, Hai-Yan Lei, Ponnie Robertlee Dolo, Xian-Cai Xiang, Guo-Qing Cao, Guo-Bin Wang, Shao-Tao Tang
Tajammool Hussein Aubdoollah, Kang Li, Xi Zhang, Shuai Li, Li Yang, Hai-Yan Lei, Ponnie Robertlee Dolo, Xian-Cai Xiang, Guo-Qing Cao, Guo-Bin Wang, Shao-Tao Tang, Department of Pediatric Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, Hubei Province, China
Author contributions: Aubdoollah TH, Li K and Zhang X contributed equally to this work; Aubdoollah TH collected and analyzed the data, and drafted the manuscript; Li S and Yang L provided analytical oversight; Aubdoollah TH and Tang ST designed and supervised the study; Zhang X, Li K, Lei HY, Dolo PR, Xiang XC and Cao GQ revised the manuscript for important intellectual content; Zhang X, Lei HY and Dolo PR offered technical or material support; Wang GB and Tang ST provided administrative support; all authors have read and approved the final version to be published.
Institutional review board statement: The Ethics Committee of Huazhong University of Science and Technology has reviewed and approved this study.
Informed consent statement: Before the consent form was signed by the parent, they were fully informed about the surgical procedure with the associated risks, additional trocar, and possibility for conversion to the open technique.
Conflict-of-interest statement: This study was supported by the Public Welfare Research and special funds were received from the National Health and Family Planning of China (No. 201402007).
Data sharing statement: The technical appendix, statistical code, and dataset are available from the corresponding author at tshaotao83@126.com. All the participants gave informed consent for data sharing when they enrolled in this study. No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Shao-Tao Tang, MD, PhD, Professor, Consultant, Department of Pediatric Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan 430022, Hubei Province, China. tshaotao83@126.com
Telephone: +86-27-85726402
Received: December 13, 2014
Peer-review started: December 16, 2014
First decision: January 22, 2015
Revised: March 13, 2015
Accepted: May 19, 2015
Article in press: May 19, 2015
Published online: August 7, 2015
Processing time: 237 Days and 22.7 Hours
Abstract

AIM: To report the clinical outcomes and ergonomics analysis of three laparoscopic approaches in the management of Hirschsprung’s disease (HD).

METHODS: There were 90 pediatric patients (63 boys, 27 girls; mean age: 3.6 ± 2.7 mo; range: 1.0-90.2 mo) who underwent laparoscopic endorectal pull-through Soave procedures for short- and long-segment HD in our hospital. Three laparoscopic approaches were used: conventional laparoscopic pull-through (CLP) in 30 patients between 2009 and 2013, single-incision laparoscopic pull-through (SILP) in 28 patients between 2010 and 2013, and hybrid single-incision laparoscopic pull-through (H-SILP) in 32 patients between 2011 and 2013. We applied the hybrid version of the single-incision approach in 2011 to preserve the cosmetic advantage of SILP and the ergonomic advantage of CLP. We retrospectively analyzed the clinical data, cosmetic results, and ergonomics of these three approaches to have a better understanding of the selection of one approach over another.

RESULTS: The CLP, SILP, and H-SILP groups were similar in regard to age, sex, transition zone, blood loss, hospital stay, and intraoperative complications. Early and late postoperative results were not different, with equal daily defecation frequency and postoperative complications. No conversion to open technique was needed and none of the patients had recurrent constipation. With proper training, the ergonomics challenges were overcome and similar operative times were registered for the general operative time in the patients < 1 year of age and the short-segment HD patients. However, significantly shorter operative times were registered compared to SILP for patients > 1 year of age (CLP and H-SILP: 120 ± 15 min and 119 ± 12 min, respectively, vs 140 ± 7 min; P < 0.05) and for long-segment HD patients (152 ± 3.5 min and 154 ± 3.6 min, respectively, vs 176 ± 2.3 min; P < 0.05). The best cosmetic result was registered with the SILP (scarless), followed by the H-SILP (near scarless appearance) and the CLP (visible scars) procedures.

CONCLUSION: Based on the results, we believed that the laparoscopic approach should be selected according to the age, transition zone, and desired cosmetic result.

Keywords: Age; Cosmetic; Ergonomic; Hirschsprung’s disease; Laparoscopic pull-through

Core tip: This manuscript describes a comparison of the (1) hybrid single-incision laparoscopic endorectal pull-through, (2) conventional laparoscopic endorectal pull-through, and (3) single-incision laparoscopic endorectal pull-through in selected Hirschsprung’s disease patients. The cosmetic advantage was not the only concern, but also the age and transition zone-relating aspects of these three approaches. The clinical outcomes and ergonomics analysis are reported in order to better understand the choice of one approach over the other with regard to the patient’s age, transitional zone, and desired cosmetic result.