Management of Hirschsprung?s disease: a comparison of Soave?s and Duhamel?s pull-through methods

Abstract

The aim of this study was to compare the safety and benefits of Soave's and Duhamel's pull-through procedures for the management of Hirschsprung's disease (HD). The patients consisted of 33 boys (85%) and six girls (15%), a ratio of 5.5:1. Their ages ranged from 1 day to 8 years. Rectal biopsy was performed to confirm the diagnosis of HD. Twenty-five patients (64%) underwent Soave's pull-through, and 13 patients (33%) underwent Duhamel's pull-through. Twenty children (80%) out of the 25 undergoing Soave's pull-through recovered uneventfully, compared with 11 out of the 13 (84%) undergoing Duhamel's pull-through. The complications following Soave's procedure included strictures in two patients (8%), enterocolitis in another two (8%), and anastomotic leakage in one (4%). Additional operations were required in two patients (8%). The complications following Duhamel's procedure included stricture in one patient (7.6%) and enterocolitis in another (7.6%). An additional operation was required in one patient (7.6%). The rate of constipation was 16% after the Soave's pull-through compared with 15% after the Duhamel's pull-through. There was no significant difference between the two procedures in postoperative surgical morbidity or in long-term risk of enterocolitis. In the light of present findings, both procedures appear comparable in terms of efficiency and associated complications.

" The Laparoscopic Assisted Duhamel Pull through Procedure for Hirschsprung’s Disease: Our Technique and Short Term Results "

“…The incidence of HD is 1 in 5,000 live births [1,2]. The HD was first described in 1886, since than many procedures has been described for its management [1][2][3][4][5][6][7][8].…”

“…The HD was first described in 1886, since than many procedures has been described for its management [1][2][3][4][5][6][7][8]. In recent years laparoscopy has evolved in the management of HD from extramucosal biopsy to primary definitive management [3].…”

“…The Hirschsprung's disease (HD) is characterized by absence of ganglion cells in the Myentric and Meissners plexus' with nerve bundle hyperplasia [1,2]. The surgery for HD is changed from multistage surgery to single stage.…”

“…In the Duhamel procedure, a section of aganglionic rectum is left in situ and anastomosed to pulled down segment of ganglionic colon (side-to-side) as a pouch reservoir. Duhamel procedure has gained popularity due to technical ease, minimal anal stretching and better visibility in entire procedure [2,3]. The author has been performing the open staged Duhamel operations for HD since 20 yrs and laparoscopic assisted Duhamel pull through (LADPT) for last 2 years.…”

Abaixamento endoanal do colón no tratamento da moléstia de Hirschsprung

“…A incidência de constipação no pós-operatório varia de 6 a 34% (Tariq et al, 1991;Rescorla et al, 1992;Marty et al, 1995;Yanchar & Soucy, 1999;Saleh et al, 2004).…”