Surgical strategies for total colonic aganglionosis: a retrospective comparative study

The study aimed to evaluate different surgical techniques in total colonic aganglionosis cases.

Twenty patients were included in this study. A total colectomy, except for the lower rectum in cases of Duhamel's. The average age for an ileal pull-through in ileostomized cases was 1 year; ileostomy closure was performed after 3 years. In eight non-ileostomized cases, surgery was performed at 2-3 years of age. Group A comprised 10 cases that underwent direct ileoanal pull-through (seven open and three laparoscopic), while Group B comprised 10 cases that underwent Duhamel's procedure (six laparoscopic and four open). Operative details and postoperative outcomes were recorded for the entire cohort. Comparative statistical analysis was performed on patients with complete follow-up data (n = 20).

All patients were followed up for 5 years after surgery. Postoperative complications included fecal incontinence, perianal dermatitis, electrolyte disturbances, enterocolitis, and constipation. Fecal incontinence and electrolyte disturbances were more frequently observed after straight ileoanal pull-through, whereas enterocolitis and constipation were more common after Duhamel's procedure. No anastomotic leakage was reported. Comparative analysis showed no statistically significant differences between the two techniques.

No clear superiority was demonstrated between straight ileoanal pull-through and Duhamel's procedure in patients with total colonic aganglionosis. Each technique was associated with a distinct pattern of complications, and larger studies are needed to better define optimal surgical management.