Clinical, manometric and profilometric evaluation after surgery for Hirschsprung's disease: comparison between the modified Duhamel and the transanal rectosigmoidectomy techniques

Abstract

PURPOSE: To evaluate fecal continence, anorectal manometry (AM) and profilometry (P), in patients operated for congenital megacolon, using either the modified Duhamel technique (MDT) or the modified transanal rectosigmoidectomy (MTR) technique. METHODS: 42 patients were evaluated clinically and via AM and P, for postoperative control. The resting, coughing, voluntary contraction, maintained voluntary contraction and perianal stimulation pressures were investigated. The rectosphincteric reflex was tested and the simple and enhanced pressure curves were evaluated. The three-dimensional profilometric outline was produced. Student's t, chi-squared and Fisher's exact tests were used for statistical analysis (p<0.05). RESULTS: AM showed mean resting pressures of 53.44 mmHg for MDT and 60.67 mmHg for MTR, and mean voluntary contraction pressures of 94.50 mmHg for MDT and 95.47 mmHg for MTR. There was no statistical difference between the groups. The shapes of the simple and enhanced pressure curves did not present any statistical difference, independent of the surgical technique used. CONCLUSION: The two surgical techniques were equivalent. MDT caused greater incidence of postoperative constipation that MTR did. AM and P were shown to be excellent tests for postoperative follow-up among these patients.

Bowel Function and Quality of Life After Transanal Endorectal Pull-through for Hirschsprung Disease

“…This compares favorably with the rates of up to 38% that have been reported in series after Duhamel, Soave, and Swenson procedures. 5,14,[41][42][43][44][45] The estimated prevalences for fecal incontinence after these procedures have ranged between 13% and 17%, 41-43 7% and 34%, and 21% and 29%, 42,46 respectively, with a notion of some improvement in symptoms over time. 5,14,42,43 Although our assessment showed that fecal control following TEPT was initially inferior to controls during childhood, by adulthood, these problems can largely be expected to resolve.…”

“…The reported rates for enterocolitis have ranged from 1% to 39% for Duhamel operation, 14,42,44 6% to 23% for Soave procedure, 23,42 25% to 28% for Swenson and Boley procedures 47 over follow-up periods ranging from 0.5 to 29 years. Although our study suggested that up to 54% of patients may experience at least 1 episode of enterocolitis after TEPT and 21% may experience !4 episodes, these reflect the results of a detailed cumulative enquiry and a long follow-up period of up to 32 years.…”

Duhamel and Transanal Endorectal Pull-throughs for Hirschsprung' Disease: A Systematic Review and Meta-analysis

“…Six studies 16,[18][19][20][21][22] were given four to six stars corresponding to a moderate risk of bias, and only one study 17 was given eight stars corresponding to a low risk of bias. Methodological weaknesses common to all studies included inadequate selection of both operative groups as all seven articles [16][17][18][19][20][21][22] were retrospective cohort studies. Demographic features and follow-up descriptions varied between studies (►Table 1).…”

“…Demographic features and follow-up descriptions varied between studies (►Table 1). Three studies [20][21][22] did not report duration of follow-up. In one study, 18 duration of follow up was too short for some of the outcomes to be accurately assessed, and another study 19 did not explain the large number of subjects that missed follow-up.…”

“…Five studies (315 patients) [17][18][19][20]22 reported postoperative enterocolitis in 40 patients (10/174 Duhamel, 30/141 TEPT) (►Table 2). The mean incidence of postoperative enterocolitis was 21.3% (range: 0-35.1%) in the TEPT compared with 5.7% (range: 3.6-11.8%) in the Duhamel pull-through.…”