Aims: To prospectively evaluate the laparoscopic assisted Duhamel pull through (LADPT) procedure for Hirschsprung's disease at our centre.
Material and methods:After clinico-radiological diagnosis of Hirschsprung's disease junctional colostomy and mutltiple seromuscular biopsy was taken. After histological confirmation of diagnosis definitive surgery was done by laparoscopic assisted Duhamal procedure. Mobilization of aganglionic bawel and colon proximal to leveling colostomy was done laproscopically. The leveling colostomy taken down, bowel divided at the ganglionic segment, proximal colon pulled into retro-rectal avascular tunnel, all through the colostomy incision. Transanal stapled side to side colo-rectal anastomosis was done with rectal stump closure. Results: Mean age of surgery was 6.0±0.23 months comparable in both groups (ranged 3 m-5 yrs). Mean operative time, blood loss and hospital stay with range were 80±0.30 (70-100 minutes), 50±0.20 (40-90 ml) and 6±0.21 (3-12 days) less in LADPT cases compared with open Duhamel (p value .008, 0.0067 and .009 respectively). Per-operative one left ureteric injury occurred in LADPT. In one year of follow-up revision LADPT (for neuronal intestinal dysplasia) and reexploration due to small bowel stricture were needed in one patient each, there was one death due to fulminant enterocolitis.
Conclusions:In terms of ease of mobilization of the rectum and sigmoid colon, hemostasis, shorter operative time, less analgesic requirement, early postoperative recovery and small abdominal scar LADPT is a feasible procedure for Hirschsprung's Disease with a junctional colostomy.