{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T23:41:57Z","timestamp":1760139717034,"version":"build-2065373602"},"reference-count":39,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2022,4,21]],"date-time":"2022-04-21T00:00:00Z","timestamp":1650499200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Children"],"abstract":"<jats:p>Intestinal aganglionosis in children is a common cause of neonatal and infantile obstruction or ileus. Diagnosis is based on a histologically proven absence of enteric ganglion cells in deep biopsies of the gut wall. Therapeutic goal is a one-stage repair with a resection of the affected segment. The endorectal pull-through (ERP) can be performed entirely transanally in a lot of the cases. In patients with difficult preparation or a high aganglionosis ERP often needs to be assisted by laparoscopy or laparotomy. We present two cases with a technical modification performing a totally transanal pull-through colectomy without any trocars other than an umbilical camera trocar. The procedure starts with a classical endorectal technique. Usually, the transanal preparation is limited by reaching the colon descendens. A camera trocar is inserted and under laparoscopic vision the preparation is completed placing the instruments directly via the opened anus. After reaching the healthy colon segment, the pull-through is completed transanally. One of the main advantages of ERP is the sparing dissection. Our modification combines advantages of laparoscopy and ERP. The umbilical camera allows an excellent view while the instruments for dissection are used like with ERP without any further trocar or traction of the anal sphincter. The dispensation of any transanal trocar allows a higher grade of freedom in preparation and possibly a smaller trauma on the distal anal channel.<\/jats:p>","DOI":"10.3390\/children9050588","type":"journal-article","created":{"date-parts":[[2022,4,22]],"date-time":"2022-04-22T05:07:22Z","timestamp":1650604042000},"page":"588","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Transanal Endoscopic-Assisted Pull-Through Colectomy for Children with High Intestinal Aganglionosis"],"prefix":"10.3390","volume":"9","author":[{"given":"Ulrike","family":"Metzger","sequence":"first","affiliation":[{"name":"Department of Pediatric and Adolescent Surgery, Paracelsus Medical University Hospital, 5020 Salzburg, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4071-1961","authenticated-orcid":false,"given":"Armin-Johannes","family":"Michel","sequence":"additional","affiliation":[{"name":"Department of Pediatric and Adolescent Surgery, Paracelsus Medical University Hospital, 5020 Salzburg, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mircia-Aurel","family":"Ardelean","sequence":"additional","affiliation":[{"name":"Department of Pediatric and Adolescent Surgery, Paracelsus Medical University Hospital, 5020 Salzburg, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Roman Patrick","family":"Metzger","sequence":"additional","affiliation":[{"name":"Department of Pediatric and Adolescent Surgery, Paracelsus Medical University Hospital, 5020 Salzburg, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2022,4,21]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"164","DOI":"10.1186\/s13023-020-01362-3","article-title":"ERNICA guidelines for the management of rectosigmoid Hirschsprung\u2019s disease","volume":"15","author":"Kyrklund","year":"2020","journal-title":"Orphanet J. Rare Dis."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"96","DOI":"10.1055\/s-0036-1593991","article-title":"European Paediatric Surgeons\u2019 Association Survey on the Management of Hirschsprung Disease","volume":"27","author":"Zani","year":"2017","journal-title":"Eur. J. Pediatric Surg."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1221","DOI":"10.1016\/S0022-3468(97)90686-2","article-title":"Hirschsprung\u2019s disease: A 20-year experience","volume":"32","author":"Reding","year":"1997","journal-title":"J. Pediatric Surg."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"347","DOI":"10.1007\/s00112-017-0250-z","article-title":"Morbus Hirschsprung","volume":"165","author":"Metzger","year":"2017","journal-title":"Mon. Kinderheilkd."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"152","DOI":"10.1038\/nrgastro.2017.149","article-title":"Hirschsprung disease\u2014Integrating basic science and clinical medicine to improve outcomes","volume":"15","author":"Heuckeroth","year":"2018","journal-title":"Nat. Rev. Gastroenterol. Hepatol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"266","DOI":"10.1053\/j.sempedsurg.2008.07.005","article-title":"Hirschsprung disease","volume":"17","author":"Haricharan","year":"2008","journal-title":"Semin. Pediatric Surg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"618","DOI":"10.1007\/s12098-017-2371-8","article-title":"Hirschsprung Disease\u2014Current Diagnosis and Management","volume":"84","author":"Das","year":"2017","journal-title":"Indian J. Pediatrics"},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Haikal, Z., Dwihantoro, A., Gunarti, H. (2020). Accuracy of transition zone in contrast enema to predict intraoperative aganglionosis level in patients with Hirschsprung disease. BMC Res. Notes., 13.","DOI":"10.1186\/s13104-020-04945-2"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"188","DOI":"10.1055\/s-2006-924220","article-title":"Is the anorectal sphincter damaged during a transanal endorectal pull-through (TERPT) for Hirschsprung\u2019s disease? A 3-dimensional, vector manometric investigation","volume":"16","author":"Till","year":"2006","journal-title":"Eur. J. Pediatric Surg."},{"key":"ref_10","unstructured":"Spitz, L.W., Coran, A.G., and Teitelbaum, D.H. (2013). Hirschsprung disease. Operative Pediatric Surgery, CRC Press. [7th ed.]."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1016\/j.jpedsurg.2006.09.007","article-title":"Are the long-term results of the transanal pull-through equal to those of the transabdominal pull-through? A comparison of the 2 approaches for Hirschsprung disease","volume":"42","author":"Drongowski","year":"2007","journal-title":"J. Pediatric Surg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"774","DOI":"10.1016\/j.jpedsurg.2014.02.073","article-title":"Transanal pullthrough for Hirschsprung disease: Matched case-control comparison of Soave and Swenson techniques","volume":"49","author":"Nasr","year":"2014","journal-title":"J. Pediatric Surg."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"312","DOI":"10.1055\/s-2006-924523","article-title":"Transanal coloanal anastomosis for Hirschsprung\u2019s disease: Comparison between endorectal and perirectal pull-through procedures","volume":"16","author":"Sapin","year":"2006","journal-title":"Eur. J. Pediatric Surg."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"280","DOI":"10.1089\/lap.2011.0081","article-title":"10 years of experience with laparoscopic-assisted endorectal Soave pull-through","volume":"22","author":"Tang","year":"2012","journal-title":"J. Laparoendosc. Adv. Surg. Tech."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"256","DOI":"10.1053\/j.sempedsurg.2004.10.013","article-title":"Laparoscopic-assisted approaches for the definitive surgery for Hirschsprung\u2019s disease","volume":"13","author":"Georgeson","year":"2004","journal-title":"Semin. Pediatric Surg."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"878","DOI":"10.1007\/s00383-005-1506-6","article-title":"Prospective analysis of primary modified Georgeson\u2019s laparoscopy-assisted endorectal pull-through for Hirschsprung\u2019s disease: Short- to mid-term results","volume":"21","author":"Ishihara","year":"2005","journal-title":"Pediatr Surg Int."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"595","DOI":"10.1089\/lap.2014.0343","article-title":"Hybrid Single-Incision Laparoscopic Approaches for Endorectal Pull-Through in Hirschsprung\u2019s Disease","volume":"25","author":"Aubdoollah","year":"2015","journal-title":"J. Laparoendosc. Adv. Surg. Tech. Part A"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1950","DOI":"10.1007\/s11605-010-1299-3","article-title":"Single-incision laparoscopic endorectal pull-through (SILEP) for Hirschsprung disease","volume":"14","author":"Muensterer","year":"2010","journal-title":"J. Gastrointest. Surg. Off. J. Soc. Surg. Aliment. Tract"},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Nguyen, L.T., Nguyen, A.T., Nguyen, Q.T., Tran, Q.A., Bui, H.D., and Pham, H.D. (2021). Suspension sutures facilitate single-incision laparoscopic-assisted rectal pull-through for Hirschsprung disease. BMC Surg., 21.","DOI":"10.1186\/s12893-021-01260-w"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"695","DOI":"10.1089\/lap.2009.0148","article-title":"Experience with modified single-port laparoscopic procedures in children","volume":"19","author":"Rothenberg","year":"2009","journal-title":"J. Laparoendosc. Adv. Surg. Tech."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1919","DOI":"10.1016\/j.jpedsurg.2012.11.044","article-title":"Single-incision laparoscopic versus conventional laparoscopic endorectal pull-through for Hirschsprung\u2019s disease: A comparison of short-term surgical results","volume":"48","author":"Tang","year":"2013","journal-title":"J. Pediatric Surg."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"8903","DOI":"10.3748\/wjg.v21.i29.8903","article-title":"Clinical outcomes and ergonomics analysis of three laparoscopic techniques for Hirschsprung\u2019s disease","volume":"21","author":"Aubdoollah","year":"2015","journal-title":"World J. Gastroenterol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"3107","DOI":"10.1007\/s00464-015-4555-5","article-title":"An experimental study in six fresh human cadavers using a novel approach to avoid abdominal wall incisions in total colectomy: Totally transanal laparoendoscopic single-site pull-through colectomy with J-pouch creation","volume":"30","author":"Vahdad","year":"2016","journal-title":"Surg. Endosc."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"276","DOI":"10.1089\/lap.2012.0058","article-title":"Totally transanal LESS pull-through colectomy: A novel approach for avoiding abdominal wall incision in children with long-segment intestinal aganglionosis","volume":"23","author":"Vahdad","year":"2013","journal-title":"J. Laparoendosc. Adv. Surg. Tech. Part A"},{"key":"ref_25","first-page":"425","article-title":"Totally Transanal Laparo-Endoscopic Single-Site ProctoColectomy-Ileoanal J-Pouch (TLPC-J): An Experimental Study of a Novel Approach","volume":"40","author":"Vahdad","year":"2015","journal-title":"Iran. J. Med. Sci."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1020","DOI":"10.1089\/lap.2013.0180","article-title":"Notes for surgical treatment of long-segment Hirschsprung\u2019s disease: Report of three cases","volume":"23","author":"Li","year":"2013","journal-title":"J. Laparoendosc. Adv. Surg. Tech. Part A"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"255","DOI":"10.1089\/lap.2008.0211","article-title":"A NOTES modification of the transanal pull-through","volume":"19","author":"Velhote","year":"2009","journal-title":"J. Laparoendosc. Adv. Surg. Tech. Part A"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1283","DOI":"10.1016\/S0022-3468(98)90169-5","article-title":"Transanal endorectal pull-through for Hirschsprung\u2019s disease","volume":"33","year":"1998","journal-title":"J. Pediatric Surg."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1016\/j.jss.2017.01.014","article-title":"Lateral thermal damage of mesoappendix and appendiceal base during laparoscopic appendectomy in children: Comparison of the harmonic scalpel (Ultracision), bipolar coagulation (LigaSure), and thermal fusion technology (MiSeal)","volume":"212","author":"Perko","year":"2017","journal-title":"J. Surg. Res."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"910","DOI":"10.1016\/j.jpedsurg.2006.01.009","article-title":"Minimal access surgery in neonates and infants","volume":"41","author":"Almaramhi","year":"2006","journal-title":"J. Pediatric Surg."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1097\/00005237-200701000-00010","article-title":"Minimally invasive neonatal surgery","volume":"21","author":"Harres","year":"2007","journal-title":"J. Perinat. Neonat. Nurs."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1605","DOI":"10.1089\/lap.2019.0165","article-title":"Minimally Invasive Techniques for Hirschsprung Disease","volume":"29","author":"Iacusso","year":"2019","journal-title":"J. Laparoendosc. Adv. Surg. Tech."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"249","DOI":"10.1053\/j.sempedsurg.2014.09.004","article-title":"Minimal invasive surgery in the newborn: Current status and evidence","volume":"23","author":"Lacher","year":"2014","journal-title":"Semin. Pediatric Surg."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1007\/s00104-009-1847-0","article-title":"Minimal-invasive Kinderchirurgie","volume":"81","author":"Metzelder","year":"2010","journal-title":"Der Chirurg"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"851","DOI":"10.1016\/j.clp.2017.08.006","article-title":"Minimally Invasive Neonatal Surgery: Hirschsprung Disease","volume":"44","author":"Yamataka","year":"2017","journal-title":"Clin. Perinatol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"304","DOI":"10.1542\/peds.2005-2736","article-title":"Pediatric minimal-access surgery: Update 2006","volume":"118","author":"Zitsman","year":"2006","journal-title":"Pediatrics"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"96","DOI":"10.1053\/j.sempedsurg.2009.11.016","article-title":"Transanal endorectal pull-through for Hirschsprung disease: Technique, controversies, pearls, pitfalls, and an organized approach to the management of postoperative obstructive symptoms","volume":"19","author":"Langer","year":"2010","journal-title":"Semin. Pediatric Surg."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"308","DOI":"10.1016\/j.jpedsurg.2011.11.025","article-title":"Duhamel pull-through for Hirschsprung disease: A comparison of open and laparoscopic techniques","volume":"47","author":"Nah","year":"2012","journal-title":"J. Pediatric Surg."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1053\/j.sempedsurg.2019.04.013","article-title":"Error traps and culture of safety in Hirschsprung disease","volume":"28","author":"Wehrli","year":"2019","journal-title":"Semin. Pediatric Surg."}],"container-title":["Children"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2227-9067\/9\/5\/588\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T22:58:09Z","timestamp":1760137089000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2227-9067\/9\/5\/588"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,4,21]]},"references-count":39,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2022,5]]}},"alternative-id":["children9050588"],"URL":"https:\/\/doi.org\/10.3390\/children9050588","relation":{},"ISSN":["2227-9067"],"issn-type":[{"type":"electronic","value":"2227-9067"}],"subject":[],"published":{"date-parts":[[2022,4,21]]}}}