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Published on: September 11, 2012
Long-term outcome and colonic motility after the Duhamel procedure for Hirschsprung's disease
C T Baillie1, S E Kenny, R J Rintala
1Department of Paediatric Surgery and University of Liverpool, Alder Hey Children's Hospital, England.
Insights
The Duhamel operation for Hirschsprung
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Colorectal Surgery
Background:
- Hirschsprung's disease (HSCR) is a congenital condition affecting the colon.
- The Duhamel-type operation is a surgical procedure used to treat HSCR.
Purpose of the Study:
- To evaluate the long-term functional outcomes in children after the Duhamel-type operation for HSCR.
- To assess colonic motility and transit time in these patients.
Main Methods:
- A cohort of 91 children who underwent Duhamel or Lester Martin Modified Duhamel operations for HSCR between 1980 and 1991 were studied.
- Functional outcomes were assessed via questionnaire, and colonic transit time (CTT) was measured using the saturation method.
- A control group of 22 healthy children was included for comparison.
Main Results:
- Patients who underwent the Duhamel procedure showed significantly worse outcome scores compared to controls, particularly those with rectosigmoid, long segment, or total colonic aganglionosis.
- Prolonged colonic transit time, especially in the rectosigmoid region, was observed in the rectosigmoid aganglionosis group.
- Only 42% of patients achieved a satisfactory long-term outcome, with 79% of those over 14 years old achieving satisfactory outcomes.
Conclusions:
- The Duhamel procedure, similar to other pull-through techniques, is linked to considerable long-term morbidity in patients with Hirschsprung's disease.
- The underlying causes of this long-term morbidity remain poorly understood.
Background/Purpose:
The aim of this study was to investigate long-term functional outcome and colonic motility in children who had undergone the Duhamel-type operation for Hirschsprung's disease (HSCR).
Methods:
All patients (n = 91) who underwent the Duhamel or Lester Martin Modified Duhamel operation for HSCR from 1980 to 1991 were included in the study. Twenty-two healthy age-matched children were used as controls. Functional outcome was assessed by questionnaire (response rate 100%). Total and segmental colonic transit time (CTT) was determined using the saturation method (80% participation rate).
Results:
Outcome scores were significantly worse in the study group for patients with rectosigmoid (RS, P < .001), long segment (LS, P < .001), and total colonic (TC) aganglionosis (P < .05), when compared with controls. The CTT was significantly prolonged in the RS group (P = .01) compared with LS, TC, and control groups; this was caused by prolonged "rectosigmoid" transit in the RS group compared with controls (P = .012). There was a positive linear correlation (P = .0002) between age and outcome score in patients with RS disease unrelated to CTT. Nine patients required a late long-term enterostomy. A satisfactory outcome (defined as outcome score > or = 10th percentile of the control group, and absence of stoma or requirement for major revisional surgery) was seen in only 42% of patients overall and in 79% of patients over 14 years of age.
Conclusions:
The Duhamel procedure, in common with other pull-through procedures, is associated with significant long-term morbidity, the aetiology of which is poorly understood.
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