Treatment of Hirschsprung's disease with a modified Duhamel-Grob-Martin operation

Since 1965 we have treated Hirschsprung's disease with a modified Duhamel-Grob-Martin operation. During this time, there have been many changes in principles of treatments and the operative technique has been reinforced. It will be divided into three different periods. From 1965 to 1980, 202 cases of Hirschsprung's disease were treated with a modified Duhamel-Grob-Martin procedure. This method had several advantages--minimum complications; good fecal control and continence; and no enlargement of the remaining colon--but anastomotic leakage and local infection were the main disadvantages. Since 1980 the operation technique has been reinforced in several points: complete preoperative colon preparation; selection of suture materials; and gentle, meticulous, and accurate surgical technique. Forty-six more patients were treated. No anastomotic leakage and local infection were experienced in this group. From April 1984 to January 1990, all patients with Hirschsprung's disease received the pull-through procedure without the colostomy even in the neonates. Eighteen infants less than 2 months of age have been treated. All patients survived the operation without any significant complications.