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Total laparoscopic modified Duhamel operation in combination with transanal endoscopic microsurgery.
[hirschsprung disease]
Laparoscopic-assisted
colonic
resection
has
been
well
described
for
multiple
surgical
indications
and
typically
requires
an
abdominal
incision
for
specimen
removal
that
is
associated
with
most
of
the
postoperative
pain
.
We
report
the
total
laparoscopic
modified
Duhamel
operation
for
megacolon
in
combination
with
transanal
endoscopic
microsurgery
for
transanal
specimen
retrieval
and
anastomosis
to
avoid
the
additional
abdominal
extraction
incision
.
Two
cases
are
presented
:
case
1
was
a
15
-
year
-old
boy
who
presented
with
intermittent
abdominal
distention
,
pain
,
and
constipation
for
3
years
'
duration
and
was
diagnosed
with
Hirschsprung
disease
,
and
case
2
was
a
60
-
year
-old
man
who
presented
with
repeated
attacks
of
incomplete
intestinal
obstruction
for
2
years
'
duration
and
was
diagnosed
with
adult
megacolon
.
They
were
treated
by
the
total
laparoscopic
modified
Duhamel
operation
without
an
abdominal
extraction
incision
in
combination
with
transanal
endoscopic
microsurgery
.
The
operations
were
successfully
accomplished
without
conversion
to
open
surgery
.
The
patients
tolerated
the
procedure
well
,
complained
of
minimal
postoperative
pain
,
and
did
not
require
narcotics
beyond
the
day
of
the
operation
.
No
surgical
complications
occurred
.
Discharge
from
the
hospital
occurred
on
the
ninth
postoperative
day
in
case
1
and
the
13
th
postoperative
day
in
case
2
.
The
total
laparoscopic
modified
Duhamel
operation
in
combination
with
transanal
endoscopic
microsurgery
is
a
feasible
and
minimally
invasive
technique
for
idiopathic
megacolon
and
adult
megacolon
.
This
advanced
surgical
technique
was
developed
by
combining
laparoscopy
with
the
concept
of
natural
orifice
transluminal
endoscopic
surgery
.