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Experience with a modification of Duhamel-Grob-Martin operation for the treatment of Hirschsprung's disease
Abstract:
Forty-two patients have been operated upon with the Duhamel-Grob-Martin operation to which has been added a partial sphincterotomy. Three patients developed anastomotic leaks and one of these died. In follow-up studies from 2 months to 9 years after operation, all patients were relieved of distension and constipation, except two, who were considered to have had an incomplete proximal resection of aganglionic bowel. There were two children with repeated attacks of enterocolitis after operation. Fecal control was good in all and, in spite of the retention of a considerable spur, there have been no problems from this. It is considered that the internal sphincter is involved in the disease and the possibility of persistent obstructive symptoms is reduced by the internal sphincterotomy which has not resulted in incontinence.
Insights
The Duhamel-Grob-Martin operation with partial sphincterotomy effectively treated Hirschsprung disease, relieving constipation and distension. Internal sphincterotomy reduced obstructive symptoms without causing incontinence in most patients.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Colorectal Surgery
Background:
- Hirschsprung disease is a congenital condition causing intestinal obstruction.
- The Duhamel-Grob-Martin operation is a standard surgical approach.
- The role of the internal sphincter in Hirschsprung disease is debated.
Purpose of the Study:
- To evaluate the efficacy and safety of the Duhamel-Grob-Martin operation combined with partial internal sphincterotomy.
- To assess the impact of internal sphincterotomy on obstructive symptoms and fecal control.
- To determine the long-term outcomes in patients with Hirschsprung disease.
Main Methods:
- A retrospective review of 42 patients undergoing Duhamel-Grob-Martin operation with partial sphincterotomy.
- Analysis of surgical outcomes, including anastomotic leaks and mortality.
- Long-term follow-up assessing symptom relief (distension, constipation), enterocolitis, and fecal continence.
Main Results:
- Overall, 39 of 42 patients experienced relief from distension and constipation.
- Two patients required reoperation due to incomplete resection of aganglionic bowel.
- Two patients had recurrent enterocolitis; fecal control was good in all patients, with no incontinence reported.
Conclusions:
- Partial internal sphincterotomy is a safe adjunct to the Duhamel-Grob-Martin operation for Hirschsprung disease.
- This combined approach effectively reduces obstructive symptoms and maintains fecal continence.
- Internal sphincter involvement is likely in Hirschsprung disease, and sphincterotomy mitigates persistent obstructive symptoms.
