Developing expertise in laparoscopic management of total colonic aganglionosis cases: Duhamel vs. Swenson procedures

To describe technical evolution of minimally invasive surgery (MIS) for total colonic aganglionosis (TCA) either Duhamel or Swenson procedures conducted by a single pediatric surgical team.

18 children with histologically proven TCA were managed between March 2018 and March 2022. All underwent laparoscopic definitive pull-through: Group A (n = 8) received laparoscopic-assisted transanal Swenson-type ileoanal pull-through, and Group B (n = 10) underwent laparoscopic Duhamel procedure. Thirteen patients presented with a pre-existing ileostomy; five were primary cases. Pre-operative evaluation included contrast enema and full-thickness rectal biopsy in every patient.

Median age at definitive surgery was 3 years (range 18 months-5 years; mean ± SD = 3.0 ± 0.9 years). Median operative time was 4 h (range 3.5-5.5 h) for Group A and 5 h (range 4.5-6 h) for Group B. Median follow-up was 5 years (range 3-6 years). Early complications included two anastomotic stenoses (Group A) successfully treated with dilatation. No anastomotic leaks occurred. Median daily stool frequency at 6 months was 7 (range 5-10) in Group A vs. 5 (range 4-7) in Group B, improving to 3 (range 2-4) and 2 (range 1-3), respectively, by last follow-up. Fecal incontinence occurred in two patients (Group A). Three patients required loperamide and six cases used dietary fiber modification.

Laparoscopic management of TCA is safe and feasible. Both Swenson-type and Duhamel approaches yield acceptable continence and growth outcomes, with the choice tailored to rectal anatomy and continence risk.