Anorectal changes and clinical outcomes after the Duhamel operation

Surgery for Hirschsprung's disease (HD) generally results in a satisfactory outcome, but some patients continue to have bowel dysfunction. There are very few studies in the literature that compare the early and late clinical outcomes.

To evaluate changes in anorectal function and clinical outcome with age in patients who underwent Duhamel operation (DO) for HD.

Twenty-eight patients who had previously undergone DO to treat HD were invited to an outpatient clinic upon reaching adulthood to participate in follow-ups. The patients' clinical data from the early and mid-term follow-ups were evaluated retrospectively based upon the hospital records and datasets from previous studies. The functional outcome tests in adulthood included anorectal manometry, rectoanal inhibitory reflex, maximum anal resting pressure, and a questionnaire.

Among the patients that reached adulthood and underwent early and mid-term evaluations, only 10 responded to the invitation and attended. That study population was comprised of 8 males and 2 females, ranging in age from 19 years to 25 years, with an average of 21.57 years. The anorectal inhibitory reflex was abnormal in 6 of the patients (66.7%). While the rate of patients who were deemed clinically "good" at the early postoperative evaluation was 53%, that rate reached to 90% in the adult evaluation.

Improvement correlated with age, while other anorectal manometric parameters were unchanged. Long-term adult follow-up is essential for objectively evaluating surgical outcomes and overall success.