Neonatal Duhamel's pull-through for Hirschsprung's disease.

Area of Science:

• Pediatric Surgery
• Gastroenterology
• Neonatal Care

Background:

• Hirschsprung's disease (HD) is a congenital condition affecting the large intestine.
• Surgical intervention is necessary for HD management.
• Comparing different surgical approaches for neonatal HD is crucial for optimal outcomes.

Purpose of the Study:

• To compare the neonatal Duhamel's pull-through procedure with other surgical approaches for Hirschsprung's disease diagnosed in neonates.
• To evaluate operative outcomes, complications, and functional results of different Duhamel's pull-through variations.

Main Methods:

• A retrospective study of 50 Hirschsprung's disease patients undergoing Duhamel's pull-through.
• Patients were divided into three groups: neonatal pull-through (Group I), delayed one-stage pull-through (Group II), and two-stage pull-through (Group III).
• Analysis included operative bleeding, operative time, complications (enterocolitis, fecaloma), and functional results.

Main Results:

• The two-stage pull-through group (Group III) experienced significantly more bleeding and longer operative times (p < 0.001).
• Post-operative enterocolitis and fecaloma rates were similar across all groups (p = 0.826 and 0.868, respectively).
• Functional outcomes were good in most patients and not statistically different among the groups (p = 0.184).

Conclusions:

• Neonatal Duhamel's pull-through, particularly with an endo-GIA stapler, is a successful treatment for Hirschsprung's disease in neonates.
• Neonatal Duhamel's procedure offers functional results comparable to delayed or two-stage approaches.
• Early surgical intervention in neonates can prevent the need for home enemas or stomas, improving quality of life.