Duhamel operation for children with distal colonic dysmotility
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Published on: December 15, 2023
Yew-Wei Tan1, Osvaldo Borrelli2, Keith Lindley2
1Specialist Neonatal and Paediatric Surgery Department, Great Ormond Street Hospital for Children, London, WC1N 3JH, UK. ywtan80@doctors.net.uk.
Insights
The Duhamel operation resolved refractory constipation in 82% of pediatric patients with distal colonic dysmotility. However, half of these children required antegrade continence enemas (ACE) post-surgery.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Colorectal Surgery
Background:
- Constipation refractory to medical management is a significant challenge in children.
- Manometrically proven distal colonic dysmotility often necessitates surgical intervention.
- The Duhamel operation is a surgical option for complex pediatric constipation.
Purpose of the Study:
- To evaluate the outcomes of the Duhamel operation in children with intractable constipation and distal colonic dysmotility.
- To assess the resolution of constipation and postoperative complications following the Duhamel procedure.
- To determine the long-term efficacy of the Duhamel operation in this patient population.
Main Methods:
- Retrospective review of children who underwent the Duhamel operation for intractable constipation and left colonic dysmotility since 2009.
- Analysis of primary endpoint: resolution of constipation.
- Analysis of secondary endpoint: postoperative complications, including small bowel obstruction.
Main Results:
- Eleven patients (median age 11 years) with refractory constipation and distal colonic dysmotility underwent the Duhamel operation.
- Constipation resolved in 82% of patients (9/11), with 4 requiring antegrade continence enemas (ACE) and 5 managed with laxatives.
- Two patients (18%) had persistent constipation and incontinence, ultimately requiring an ileostomy. Two postoperative small bowel obstructions occurred.
Conclusions:
- The Duhamel operation is effective in resolving refractory constipation in 82% of children with manometrically proven distal colonic dysmotility.
- Half of the patients who achieved resolution required subsequent antegrade continence enemas (ACE).
- The Duhamel procedure offers a viable surgical solution for severe pediatric constipation cases unresponsive to conservative management.
Purpose:
To report outcomes of children with constipation refractory to medical management and manometrically proven distal colonic dysmotility, managed with rectosigmoidectomy followed by Duhamel operation (Duhamel).
Methods:
Children who underwent a Duhamel from 2009 onwards for intractable constipation and left colonic dysmotility were retrospectively reviewed. The primary end point was resolution of constipation, and secondary end point was postoperative complications. Continuous data were median (range).
Results:
11 patients (4 males) had Duhamel at 11 years (5-16) with constipation started from 2 years (1-8). Hirschsprung's disease was excluded. All Duhamels were performed with a covering ileostomy: 9 following a Hartmann procedure, one following a previously failed reversal of Hartmann, and one Duhamel performed with a pre-existing ileostomy. All ileostomies were subsequently closed. Median resection length was 22 cm (11-31). Length of stay was 8 days (5-23). Follow-up was 5 years (0.5-7). Age at final review was 15 years (10-18). Resolution of constipation occurred in nine patients (4 required antegrade continence enemas (ACE), 5 with laxative); two had persistent constipation and faecal incontinence despite ACE, ultimately requiring an ileostomy. Two postoperative small bowel obstructions required laparotomy.
Conclusion:
Duhamel performed in children with manometrically proven distal colonic dysmotility yielded 82% resolution of refractory constipation; half of them subsequently needed ACE.
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