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Abstract
Objective To evaluate the feasibility and clinical efficacy of a modified Deloyers procedure with transection of the ileocolic vascular pedicle under indocyanine green (ICG) fluorescence laparoscopic
guidance for long-segment Hirschsprung's disease (HD) with a extremely short remaining ascending colon.
Methods A retrospective analysis was conducted. 12 children who underwent the modified Deloyers
procedure due to insufficient length of the ascending colon at the Department of General Surgery, Capital
Center for Children's Health, Capital Medical University from January 2019 to December 2024 were selected as study group. Intraoperatively, under the ICG fluorescence laparoscopy monitoring, the ileocolic vascular pedicle was temporarily clamped. After confirming adequate blood supply to the distal ascending colon, the pedicle was transected, followed by standard counterclockwise rotation and pull-through anastomosis. Another 14 children who underwent the ICG fluorescence laparoscopy-assisted conventional Deloyers procedure from August 2022 to December 2023 were selected as the control group. The intraoperative length of the preserved colon, the incidence of postoperative complication and postoperative bowel function were compared between the two groups. Statistical analysis were performed by t-test, Mann-Whitney U test, and Fisher exact probability method. Results All surgeries were successfully completed. The length of the preserved colon in the study group was significantly shorter than that in the control group [(7.08±3.90) cm vs (12.77±2.86) cm, P<0.05]. There were no statistically significant differences between the two groups in terms of postoperative complication incidence, such as postoperative daily stool frequency, soiling, perianal skin erosion, or enterocolitis, etc. (all P>0.05). In the study group, no anastomotic complication occurred after the application of the fluorescence laparoscopy technique. Conclusions The modified Deloyers procedure with transection of the ileocolic vascular pedicle, guided by ICG fluorescence laparoscopic blood flow assessment, is safe and feasible. This technique significantly extends the limit of usable colon length and provides a new radical surgical option for children with HD and a extremely short remaining ascending colon.
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2026, Vol. 14 
