Soave procedure versus duhamel procedure for the treatment of hirschsprung's disease

ABSTRACT

To compare the outcome and cost effectiveness of Soave's and Duhamel's procedures in patients with Hirschsprung's disease in our setup. Patients with clinical suspicion of Hirschsprung's disease were admitted to Paediatric Surgery Unit of PGMI/LRH, Peshawar from July 1998 to July 2003. Diagnosis was confirmed with full thickness rectal biopsy. Colostomy or ileostomy was performed. Stoma was utilized in all patients as a part of the pull-through operation. Staple [GIA 75TLC] was applied in Duhamel procedure with covering ileostomy or colostomy, while no covering stoma was provided in Soave procedure. Postoperative course was monitored and any complication encountered were noted. The results of the two procedures were analysed and compared. Out of 60 patients, 30 patients had Duhamel and 30 patients had Soave procedure. Age ranged form 12 months to 5 years. In Soave procedure, postoperative complications included chronic constipation [33.33%], wound infection [16.66%], anal stenosis [13.33%] and perineal soiling [13.33%]. In Duhamel procedure postoperative complications were wound infection [33.33%], chronic constipation [16.66%] and perineal soiling [13.33%]. Postoperative mortality was 3.3% [1/30] in Duhamel procedure. Hospital Stay was 5-7 days and 7-10 days and cost of the procedure Rs 2500-3000 and Rs 15000-20000 for Soave procedure and Duhamel procedure respectively. Duhamel procedure is more costly and has no better results of surgery than Soave procedure. Hence Soave procedure is more suitable in our set up