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CC BY 4.0 · European J Pediatr Surg Rep. 2025; 13(01): e14-e18
DOI: 10.1055/a-2640-4118
Case Report

Robot-Assisted Laparoscopic Endorectal Pull-Through Combined with Deloyers Turnover in Long-Segment Hirschsprung Disease: A Case Report

Maria Stella Cipriani
1   Department of APediatric Surgery, IRCCS, Istituto Giannina Gaslini, Genoa, Italy
2   Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili, University of Genoa, Genoa, Italy
,
Maria G. Faticato
1   Department of APediatric Surgery, IRCCS, Istituto Giannina Gaslini, Genoa, Italy
,
Federica Fanti
1   Department of APediatric Surgery, IRCCS, Istituto Giannina Gaslini, Genoa, Italy
2   Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili, University of Genoa, Genoa, Italy
,
Michela C. Y. Wong
1   Department of APediatric Surgery, IRCCS, Istituto Giannina Gaslini, Genoa, Italy
,
Girolamo Mattioli
1   Department of APediatric Surgery, IRCCS, Istituto Giannina Gaslini, Genoa, Italy
2   Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili, University of Genoa, Genoa, Italy
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Funding None.
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Abstract

We report the first documented pediatric case of the Deloyers procedure performed using robotic surgery to treat a female patient with long-segment Hirschsprung disease. A 9-month-old child was diagnosed with long-segment Hirschsprung disease. Despite rectal irrigations, the patient experienced refractory constipation and enterocolitis, necessitating exploratory surgery and ileostomy. A transition zone was identified at the proximal transverse colon, with mapping biopsies confirming aganglionosis up to the splenic flexure. At 16 months of age, the child underwent a robot-assisted endorectal pull-through with ileostomy closure. Four 8-mm trocars were placed in the epigastric, left subcostal, right subcostal, and right flank regions. Dissection and mobilization extended distally beyond the peritoneal reflection and proximally to the hepatic flexure, preserving the marginal vascular arcades. The middle and right colic arteries were ligated, while the ileocolic artery was preserved. Indocyanine green fluorescence imaging confirmed adequate vascularization of the hepatic flexure. A counterclockwise 180-degree rotation of the right colon was performed. In the perineal phase, a mucosal incision above the dentate line was followed by progressive mucosectomy to reach the isolated rectum. The colon was pulled through, and a tension-free coloanal anastomosis was performed. The postoperative period was uneventful at the 6-month follow-up. Robot-assisted laparoscopic endorectal pull-through with the Deloyers procedure is a feasible and safe technique for long-segment Hirschsprung disease. Larger case series are required to assess its long-term outcomes and potential advantages. An explanatory video of the surgery is available.

Keywords

Hirschsprung disease - Deloyers technique - robotic surgery - case report

Authors' Contributions

M.G.F. and G.M. contributed to the conception and design of the work, recognizing the importance of publishing this unique and innovative case. M.S.C. and F.F. were responsible for the acquisition and detailed description of the clinical case. M.S.C. and M.C.Y.W. contributed to video editing.


Patients' Consent

Informed consent was obtained from the patient's parents for the publication of this case report and any accompanying images.




Publikationsverlauf

Eingereicht: 12. April 2025

Angenommen: 14. Juni 2025

Accepted Manuscript online:
23. Juni 2025

Artikel online veröffentlicht:
11. Juli 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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