Technical Modification of the Georgeson Procedure for Hirschsprung’s Disease: a 12 Years Experience with the Laparoscopic-Assisted Mesocolon Dissection

Introduction: Actually the primary laparoscopic endorectal colon pull-through, reported by Georgeson, is the gold standard in the treatment of Hirschsprung’s disease. In this procedure the dissection of the aganglionic colon is performed laparoscopically. We describe a technical modification of the Georgeson procedure: the laparoscopic-assisted mesocolon dissection. Methods: A retrospective analysis was performed on all patients undergoing laparoscopic pull-through for Hirschsprung’s disease, in our department, from September 2000 to March 2012. A pneumatic anchorage Hasson type 10 mm port is used for the camera (umbilical) to allow the video-assisted procedure. The two or three operative access are small abdominal port (3-5 mm). The distal ganglionic zone is initially identified by seromuscular biopsies, obtained exteriorizing the colon through the umbilical wound. A colon pedicle, preserving the marginal artery, is fashioned through a laparoscopic-assisted stage: the mesocolon dissection was performed not endoscopically, but exteriorizing the colon through the umbilical wound progressively. Then the rectal mobilization is performed transanally, using an endorectal sleeve technique. The anastomosis is performed transanally, 5 mm above the dentate line. Results: 27 patients underwent laparoscopic colon pull-through sec. Georgeson for Hirschsprung’s disease with a laparoscopic-assisted mesocolon dissection. Also patients affected by Hirschsprung’s disease long segment were treated with this video-assisted technique. Patients treated with this technique were aged between 1 month and 1 year. Intraoperatively no complications occurred and the video-assisted dissection stage was easy to perform in all patients. The post-operative course was uneventful. Conclusions: Laparoscopic-assisted colon pull-through, described by Georgeson, represents actually the gold standard in the treatment of Hirschsprung’s disease, but the totally endoscopic mesocolon dissection is encumbered by technical complexity and a significant learning-curve for the surgeon. The laparoscopic-assisted mesocolon dissection allows to simplify this stage, decreasing the rate of intra-operative complications. Moreover, this technique is also feasible in patients affected by Hirschsprung’s disease long segment