Duhamel’s procedure for Hirschsprung’s disease and the functional outcome in a tertiary care center

Abstract

Introduction: Hirschsprung’s disease (HD) is a developmental disorder caused by the migration failure of neural crest cells during intestinal development, resulting in an aganglionic colon and causing a functional obstruction in children. Duhamel’s procedure (DP) which involves excision of the aganglionic segment with retrorectal pull through, and anastomosis of the ganglionated bowel above dentate line, is one of the classical surgical procedures for HD. Materials and Methods: This retrospective study was conducted in a tertiary care center in South India. The medical records and follow-up details of 17 patients, who underwent DP for HD between January 2014 and December 2018, were obtained and evaluated. Outcomes evaluated included incidence of post-operative constipation, incontinence/soiling, enterocolitis, anastomotic stricture, and leak. Results: There were 17 patients with HD who underwent DP during the study period, among which 76.47% of patients had classical HD and 23.52% were long-segment HD. A total of 58.82% of patients presented at birth, with overall 76.47% of male predominance. Fecal soiling (29.41%), perianal excoriation (17.64%), wound infection (11.76%), post-operative enterocolitis (11.76%), stricture formation (11.76%), constipation (11.76%), and hypertension (11.76%), and adhesive bowel obstruction (5.88%) were some complications observed in this study. Most of these complications were successfully managed. Conclusion: Staged DP is safe and can address the entire spectrum of HD. Complications are less and comparable to other techniques, and with close follow-up to address the post-operative complications, good quality of life can be achieved for the children with HD.

Comparison of Complication Regarding Modified Duhamel Procedure for Hirschsprung’s Disease in Male to Female Children

“…In our study intestinal obstruction was found in 11.11% in male while 12% in female children. As compared with another study Intestinal obstruction was found in 5.8% patients [16]. In our study enterocolitis was found in 50.7% Patients.…”

Evaluation of Bowel Function on Patient Post Operative Hirschsprung Disease

“…In particular, the TAEPT technique may have certain advantages over the transabdominal Soave and Duhamel operations. 26,27 Commonly used procedures include TAEPT, Soave, and Duhamel. 26,28 Fourteen patients who received definitive surgery received treatment with the TAEPT procedure, and Duhamel treated 7 patients each (Table 2).…”