Laparoscopic Excision of an Obstructing Soave Cuff in Hirschsprung's Disease

摘要

Background: The Soave pull-through for Hirschsprung's disease leaves a muscular cuff of aganglionosis surrounding the pull-through. In some patients, this cuff can extrinsically compress the pull-through, leading to chronic enterocolitis and failure to thrive. We describe a novel technique for managing the Soave cuff as an alternative to a complete redo pull-through. Procedure: A laparoscopic excision of the intraperitoneal portion of the Soave cuff is performed, taking care to avoid injury to bladder, vas deferens, or vagina. The extraperitoneal portion of the cuff, adjacent to the bladder/vagina, is left in place. The excision is tailored to eliminate the obstruction and minimize injury to surrounding structures. Diverting colostomy is not necessary and patients are discharged the next day. Results: Three patients successfully underwent excision without any operative complications and without the need for a colostomy. They had resolution of their chronic enterocolitis. Conclusion: In patients with an obstructing Soave cuff, a laparoscopic excision should be considered as a surgical option. We found that the procedure can be effective, with little morbidity.