Release of obstructing rectal cuff following transanal endorectal pullthrough for Hirschsprung’s disease: a laparoscopic approach

Abstract

Obstructive problems secondary to a tight or a long rectal cuff following transanal endorectal pullthrough for Hirschsprung’s disease usually require redo surgery for release. Many approaches have been described. We describe the laparoscopic approach for the release of a tight or a long rectal cuff in two cases after a transanal endorectal pullthrough. Two patients had obstructive symptoms after transanal endorectal pullthrough for Hirschsprung’s disease. The first patient had a long rectal cuff that caused severe constipation with severe straining on defecation and the second patient had recurrence of symptoms with failure of spontaneous defecation with the need for an enema or a rectal tube for evacuation. A laparoscopic excision of the long rectal cuff was performed in the first patient and incision of the tight rectal cuff in the second patient. In both patients, the obstructing symptoms were because of a rectal cuff that was long in the first case and tight in the second. The procedure was completed laparoscopically with relief of symptoms and acquisition of normal defecation immediately after surgery. Approach of the rectal cuff was possible using laparoscopy and this technique facilitates release or excision of the rectal cuff when it causes obstructing symptoms without the need for extensive surgery and without the risk of causing fecal incontinence or wound disruption or infection using other more complicated techniques. 

Keywords: Hirschshprung, laparoscopy, obstruction, rectal cuff