论文部分内容阅读
Purpose: To report the clinical outcomes and ergonomics analysis of three laparoscopic approaches in the management of Hirschsprungs Disease(HD).Methods: There were 90 pediatric patients(63 boys,27 girls; mean age: 3.6 ± 2.7(1–90.2 months)who underwent laparoscopic endorectal pull-through Soave procedure for short and long segment HD in our hospital.Three laparoscopic approaches were used; conventional laparoscopic endorectal pull-through(CLEP)in 30 patients between 2009 and 2013,single-incision laparoscopic endorectal pull-through(SILEP)in 28 patients between 2010 and 2013 and hybrid single-incision laparoscopic endorectal pull-through(H-SILEP)in 32 patients between 2011 and 2013.We have developed a hybrid version of single-incision approach in 2011 to preserve the cosmetic advantage of SILEP and the ergonomic advantage of CLEP.We retrospectively analyzed the clinical data,cosmetic results and ergonomics(age and transition zone related)of these three approaches to have a better understanding of the selection of one approach over another.Results: The CLEP,SILEP and H-SILEP groups were similar in regard to age,gender,transition zone,blood loss,hospital stay,and intraoperative complications.Early and late postoperative results were not different,including equal daily defecation frequency and postoperative complications.No conversion to open technique was needed and none of the patients had recurrent constipation.Ergonomically,the CLEP and the H-SILEP had the same maneuverability and less challenging than the SILEP,with significant operative times(minutes)for patients older 1 year(SILEP v/s CLEP and H-SILEP: 140± 7 v/s 120± 15and119± 12,P< 0.05)and for patients with long segment HD(SILEP v/s CLEP and H-SILEP: 176± 2.3 v/s 152± 3.5 and 154± 3.6,P< 0.05).The operative times were insignificant for the patients <1 year old and for the short segment HD.The best cosmetic result was registered in the SILEP(scarless)followed by the HSILEP(near scarless appearance)and the CLEP(visible scars).Conclusion:The laparoscopic approach should be selected according to the age,transition zone and desired cosmetics result.