Laparoscopic Duhamel Procedure for Hirschsprung's Disease: Systematic Review and Meta-analysis.

Area of Science:

• Pediatric Surgery
• Gastrointestinal Surgery
• Surgical Outcomes Research

Background:

• The Duhamel procedure, established in 1956, is a standard surgical approach for Hirschsprung's disease (HD).
• Laparoscopic techniques have been integrated into the Duhamel procedure, maintaining its core principles.
• This study evaluates the long-term efficacy of open Duhamel (OD) versus laparoscopic Duhamel (LD) for HD treatment.

Purpose of the Study:

• To compare long-term functional outcomes between open Duhamel (OD) and laparoscopic Duhamel (LD) procedures for Hirschsprung's disease (HD).
• To determine if the laparoscopic approach offers significant advantages over the traditional open method for HD treatment.

Main Methods:

• A systematic review of studies published between 1994 and 2014 assessing functional outcomes of OD and LD procedures.
• Meta-analysis of 11 articles including 456 patients (253 OD, 203 LD).
• Calculation of odds ratios for dichotomous variables and mean differences for continuous variables.

Main Results:

• Laparoscopic Duhamel (LD) showed a significantly lower incidence of soiling/incontinence (4% vs. 11%) and need for further surgery (14% vs. 25%) compared to Open Duhamel (OD).
• LD procedures resulted in shorter hospital stays and faster time to oral feeds than OD.
• Operative time was longer for LD, but there were no significant differences in enterocolitis or constipation rates between the two methods.

Conclusions:

• The meta-analysis indicates that laparoscopic Duhamel (LD) pull-through is superior to open Duhamel (OD) for treating Hirschsprung's disease (HD).
• Further high-quality evidence from prospective, randomized controlled trials is recommended to solidify these findings.