ABSTRACT
Context: Hirschsprung's disease (HD) is one of the commonest problems requiring surgery in children. More than 95% of children present during new-born period, when they are treated with leveling colostomy and are followed with pull-through surgery a few months later, once the child has gained adequate weight to withstand a major surgery. The commonest pull through surgery done is the Duhamel retro-rectal pull-through (DRPT) repair. Settings and Design: This is a retrospective study of children who presented to one unit in our institute, a tertiary care referral hospital for children less than 12 years, with HD and underwent DRPT procedure during the period between July 2017 to June 2020. The children were evaluated after three years of follow-up for fecal incontinence and constipation. The study was conducted in children diagnosed with classical segment recto-sigmoid HD who underwent surgery. The children who were diagnosed with HD other than classical segment, who underwent primary pull through surgery and who underwent other repairs for HD were excluded from the study. Results: Thirty-two children underwent DRPT procedure during the study period. Of them, five (15.6%) children were lost on follow-up and one (3.1%) child had expired in the immediate post-operative period. Twenty-six children were included in the study. The bowel function score was calculated. The mean age of definitive surgery was 4.2 years. The follow-up period was a minimum of three years. Only two children had a "good" score of eighteen and above. Nineteen children had a "fair" score of 13-17. Five children had a "poor" score of less than thirteen, and among them, two had a "very poor" score of less than nine. The mean BFS was 13.72. Conclusions: Functional outcomes following Duhamel procedure are satisfactory, with 7.7% of children are in the fringe of requiring another surgery for constipation and pseudo-incontinence. (AU)
Subject(s)
Humans , Male , Female , Treatment Outcome , Colon/surgery , Hirschsprung Disease/therapy , Quality of Life , Health Profile , Retrospective Studies , DefecationABSTRACT
BACKGROUND@# Hirschsprung’s disease (HD) is rare in adults, since a majority of cases are corrected in childhood.@*OBJECTIVES@#The authors describe the profile of patients with HD who reached adulthood without having undergone corrective surgery. Also, they describe the outcomes of a modified Duhamel procedure in these patients, in terms of morbidity and mortality.@*METHODS@#This retrospective study, included patients 18 years old and above, diagnosed with HD who reached adulthood without having undergone definitive repair and managed surgically by the Division of Colorectal Surgery, UP-PGH from January 1, 2004 to December 31, 2014. A review from the Department Surgical Database was used and patients’ hospital records were used to fill out a Data Collection Form. Descriptive statistics were used to summarize the data.@*RESULTS@# The 13 patients included in the study were diagnosed at an average age of 16.6 (± 13.16) years. The mean age at the time of definitive surgery was 23.46 (± 6.96) years. The M:F ratio was 5.5:1. The most common presenting symptom was constipation (69.23%). All had a prior proximal bowel diversion, with a transverse loop colostomy (61.54%) being the most common. The transition zone was located in the sigmoid in a third of patients. The mean time from diagnosis to definitive surgery was 6.69 years. Eight (61.54%) have since undergone stoma reversal. There was only one (7.69%) morbidity, a superficial surgical site infection. No mortalities were reported.@*CONCLUSION@#The modified Duhamel procedure is a safe definitive surgical procedure for the adult patient with HD.
ABSTRACT
Objective To compare postoperative outcomes and complications between subtotal colectomy combined with modified Duhamel procedure and simple subtotal colectomy for severe functional constipation (SFC). Methods Between January 2006 and June 2010,40 SFC patients after strict but inefficient nonoperative treatments were randomized by number table method to control group (20 cases, receiving simple subtotal colectomy) and combined group (20 cases,receiving subtotal colectomy and modified Duhamel procedure). The selection criteria were normal colonoscopy,and abnormal dynamic proctography (DPG). The functional outcomes after surgery were assessed from 6 months to 2 years period. Results The preoperative clinical manifestations of the two groups were similar. No statistically significant difference was observed between the two groups for time for recovery of the bowel function,length of postoperative hospitalization.and the early postoperative complications (P > 0.05). Functional outcomes of combined group with CIQOL score [(110.5 ±5.0) scores],relieving of costive gastrointestinal symptoms [(79.0 ±6.5)%], recurrent constipation rate [10.0% (2/20)], satisfaction rate of defecation frequency [85.0%(17/20)], satisfaction rate of quality of life[90.0%(18/20)] were significantly better than those of control group[(90.5 ± 3.5) scores, (60.5 ± 2.8)% ,35.0%(7/20), 15.0%(3/20),20.0%(4/20)](P< 0.05). Conclusion Combined application of subtotal colectomy and modified Duhamel procedure for SFC has better outcomes.
ABSTRACT
The Duhamel procedure has been the authors' treatment of choice for children with Hirschsprung's disease over the last 15 years. Owing to advancements in instrumentation and technique, laparoscopic correction of some congenital anomalies, including congenital megacolon, have become possible. In March and May of 1997, laparoscopic Duhamel procedures were performed on a girl and boy aged 7 months and 2 years and 9 months, respectively. The primary diagnosis in both patients was Hirschsprung's disease, which was confirmed by barium-enema and mucosal suction biopsy. The boy did not need construction of a loop colostomy, while the girl had a colostomy made neonatally. Using 4 trocars, the sigmoid colon, proximal rectum, and posterior rectal wall were mobilized laparoscopically. Immdeiately after severing the proximal resection line, the proximal end was pulled down posterior to the dentate line for side-to-side anastomosis with GIA and Endo-GIA staplers perineally. The colonic remnant was then resected with staplers and harvested through the right lower quadrent port site. Operative time was 210 minutes for the boy and 200 minutes for the girl. No perioperative complications were noted, and conversion to laparotomy was never required. Regular diet was resumed 4 days (boy) and 2 days (girl) after the operations. Postoperative hospital stay was 7 days in the two cases. We successfully performed laparoscopic Duhamel procedures for the first time in Korea, and think it feasible, safe, andminimally invasive owing to size reduction of the incision and avoidence of intraperitoneal opening of the bowel.