Duhamel pull-through for Hirschsprung disease: a comparison of open and laparoscopic techniques

Abstract Purpose Various pull-through techniques, both open and laparoscopic, have been performed for Hirschsprung disease. Our study compares open and laparoscopic Duhamel pull-through. Methods After ethical approval, we reviewed all children (n = 181) with Hirschsprung disease admitted to our inst...

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Bibliographic Details
Published in:Journal of pediatric surgery 2012-02, Vol.47 (2), p.308-312
Main Authors: Nah, Shireen A, de Coppi, Paolo, Kiely, Edward M, Curry, Joseph I, Drake, David P, Cross, Kate, Spitz, Lewis, Eaton, Simon, Pierro, Agostino
Format: Article
Language:English
Subjects:
Child, Preschool
Colon - surgery
Duhamel
Enteral Nutrition
Female
Hirschsprung disease
Hirschsprung Disease - surgery
Humans
Infant
Infant, Newborn
Laparoscopic
Laparoscopy - methods
Laparotomy - methods
Length of Stay - statistics & numerical data
Male
Minimally invasive
Pediatrics
Postoperative Complications - drug therapy
Postoperative Complications - epidemiology
Postoperative Complications - surgery
Pull-through
Rectum - surgery
Retrospective Studies
Surgery
Time Factors
Treatment Outcome
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Summary:Abstract Purpose Various pull-through techniques, both open and laparoscopic, have been performed for Hirschsprung disease. Our study compares open and laparoscopic Duhamel pull-through. Methods After ethical approval, we reviewed all children (n = 181) with Hirschsprung disease admitted to our institution between 1999 and 2009. We excluded total colonic aganglionosis (n = 14), previous pull-through done elsewhere (n = 33), or follow-up performed abroad (n = 58). Open and laparoscopic pull-through were done in the same period according to surgeon preference. Data were analyzed using χ2 or Mann-Whitney U test. Results Seventy-six children had a Duhamel pull-through for rectosigmoid aganglionosis. Operative time, time to full feeds, and length of hospital stay were similar in each group. Open (n = 41) Fifteen children (37%) required 33 further procedures. Fourteen had procedures for persistent constipation, including redo Duhamel (n = 2), stoma formation (n = 2), spur division (n = 2), and dilatation/stretch/Botox/rectal biopsy/manual evacuation (n = 23). Three children had other procedures (adhesiolysis [n = 2] and incisional hernia repair [n = 1]). Laparoscopic (n = 35) Fourteen children (40%) required 30 further procedures. Eleven had procedures for persistent constipation, including redo Duhamel (n = 1), stoma formation (n = 4), spur division (n = 9), and dilatation/stretch/rectal biopsy (n = 8). Three children had other procedures (adhesiolysis [n = 1] and incisional hernia repair [n = 2]). There were 4 conversions. Conclusion Open and laparoscopic Duhamel pull-through have similar outcomes. We show that the techniques have comparable operative times and hospital stay.
ISSN:0022-3468
1531-5037
DOI:10.1016/j.jpedsurg.2011.11.025