Laparoscopic-assisted pull-through for Hirschsprung's disease.

There appears to be a trend in the management of Hirschsprung's disease toward a one-stage surgical correction in the newborn period. After the development of the one-stage laparoscopic-assisted endorectal pull-through in 1995, the minimally invasive approaches have come to dominate the surgical management of this disease. The laparoscopic-assisted pull-through is ideally suited for those patients with aganglionosis confined to the rectum, sigmoid, or proximal left colon. At the time of the operation, a laparoscopic biopsy is recommended to identify, with certainty, the site of the transition zone before performing the colonic mobilization. Advantages of this approach include reduced discomfort, the early initiation of defecation through a normally positioned ganglionic colon and rectum, and reduced postoperative hospitalization.