Vinmec International Hospital, 458 Minh Khai, Vinh Tuy, Hai Ba Trung, Hanoi, Vietnam.
Vietnam National Children's Hospital, Hanoi, Vietnam.
BMC Surg. 2021 May 31;21(1):274. doi: 10.1186/s12893-021-01260-w.
To present a surgical technique of single-incision laparoscopic-assisted endorectal pull-through (SILEP) with suspension sutures using conventional instruments for Hirschsprung disease (HD) and its long-term follow-up outcomes.
The procedure began with a 1 cm transumbilical skin incision. Three separate punctures were made in the fascia with a 5 mm scope in the middle and 5 mm and 3 mm ports for working instruments on the left and right, respectively. The first suspension suture was placed to secure the sigmoid colon to the abdominal wall. A window was created through the rectal mesentery, and dissection around the rectum was carried out. The second suspension suture was performed to suspend the rectovesical peritoneal fold or the rectovaginal peritoneal fold to the abdominal wall. Dissection around the rectum was continued downward to approximately 1 cm below the peritoneal fold. Then, the operation was completed by a transanal approach.
Forty patients underwent SILEP from March 2013 to April 2015. The median age was 2.7 months (ranging from 1 to 17 months). The mean operative time was 96 ± 23 min. No conversion to an open operation was required. The average hospitalization time was 4.5 ± 2 days. There were no intraoperative or perioperative complications. Long-term follow-up results were obtained from 38 patients. A frequency of defecation from every other day to twice a day was noted for 33 patients (86.8%) and more often for 5 patients (13.2%). Two patients had enterocolitis (5.2%).
Single-incision laparoscopic rectal pull-through with suspension sutures using conventional instruments is feasible and safe for HD with good long-term outcomes.
介绍一种使用传统器械的单切口腹腔镜辅助经肛门内拖出术（SILEP）治疗先天性巨结肠的手术技术，并报告其长期随访结果。
手术始于脐部 1cm 的小切口。在筋膜上分别做三个 5mm 的穿刺孔，中间一个用于放置 5mm 腹腔镜，左右两侧分别用于放置 5mm 和 3mm 的操作器械。首先放置第一根悬吊缝线，将乙状结肠固定于腹壁。通过直肠系膜开窗，游离直肠周围。然后进行第二根悬吊缝线操作，将直肠膀胱腹膜反折或直肠阴道腹膜反折悬吊于腹壁。继续向下游离直肠周围组织，直至腹膜反折下方约 1cm 处。最后经肛门完成手术操作。
2013 年 3 月至 2015 年 4 月，40 例患者接受了 SILEP 手术。中位年龄为 2.7 个月（1~17 个月）。平均手术时间为 96±23 分钟。无中转开放手术。平均住院时间为 4.5±2 天。无术中或围手术期并发症。38 例患者获得了长期随访结果。33 例（86.8%）患者排便频率从隔日一次增加到每天两次，5 例（13.2%）患者排便更频繁。2 例（5.2%）患者发生肠炎。
使用传统器械的单切口腹腔镜直肠拖出术联合悬吊缝线治疗先天性巨结肠是可行和安全的，具有良好的长期效果。
