Hirschsprung's disease: Long-term results of the original duhamel operation

doi:10.1016/S0022-3468(81)80011-5

Journal of Pediatric Surgery

Volume 16, Issue 4, August 1981, Pages 484-486

https://doi.org/10.1016/S0022-3468(81)80011-5 Get rights and content

Thirty children with Hirschsprung's disease were operated on according to Duhamel's original procedure during the period 1959–1963. At follow-up examination in 1965, fecaloma formation and functional disturbances, mainly soiling, were common. At subsequent follow-up study in 1978, it was found that these disorders had either decreased markedly or completely disappeared. On the basis of this experience, it is concluded that fecaloma is amenable to treatment and does not constitute a long-term problem; soiling, although initially usual, improves substantially with time; urinary incontinence is rare, and transient and rectal sensation is not impaired.

References (17)

EhrenpreisT et al.
Results of Duhamel's operation for Hirschsprung's disease
J Pediatr Surg
(1966)
SoperRT et al.
Modification of Duhamel procedure: Elimination of rectal pouch and colorectal septum
J Pediatr Surg
(1968)
DuhamelB
Une nouvelle opération pour le mégacôlon congénital: L'abaissement rétro-rectal et trans-anal du côlon et son application possible au traitement de quelques autres malformations
Presse Med
(1956)
EhrenpreisT
IkedaK
New techniques in the surgical treatment of Hirschsprung's disease
Surgery
(1967)
MartinLW et al.
A method for elimination of the blind rectal pouch in the Duhamel operation for Hirschsprung's disease
Surgery
(1967)
TalbertJL et al.
Evaluation of modified Duhamel operation for correction of Hirschsprung's disease
Ann Surg
(1974)
SieberWK et al.
Duhamel's operation for Hirschsprung's disease
Arch Surg
(1963)

There are more references available in the full text version of this article.

Cited by (29)

Laparoscopic-assisted Duhamel procedure with ex-anal rectal transection for total colonic aganglionosis
2018, Journal of Pediatric Surgery
Citation Excerpt :
In classical laparoscopic-assisted Duhamel procedure, the rectal transection is accomplished by means of an endoscopic stapler, which usually requires a larger transabdominal port (12 mm) in right low abdomen [22,23]. However, these procedures usually cannot obtain a short pouch of the rectum due to operational difficulties in pelvic cavity [8,24]. To facilitate this step for laparoscopic procedure, Nah SA et al. [21] have tried to make eversion of the rectum and Lamas-Pinheiro et al. [25] have applied the curved Endo-GIA Stapler to obtain a lower rectal transection in laparoscopic Duhamel procedure.
Laparoscopic-assisted Duhamel procedure has a larger anastomosis and a reservoir which allows early recovery of defecation frequency, but concerns have been raised regarding the long operative time, high incidence of pouchitis and Hirschsprung associated enterocolitis (HAEC). The purpose of this study was to evaluate the postoperative complications and functional outcomes for patients with TCA undergoing modified laparoscopic-assisted Duhamel procedure (MLDP) with ex-abdominal partial colectomy and ex-anal rectal transection.
From 2011 to 2014, 16 patients with TCA who underwent MLDP were reviewed at our institution. Main modified techniques were to mobilize partial bowel through abdominal stoma opening, mobilize remaining colon, and dissect the retro-rectal space using laparoscopy, pull out and transect rectum ex-anally using a linear stapling device for creation of a short rectal pouch of 35 ~ 45 mm. Seven patients who underwent classical laparoscopic Duhamel procedure (CLDP) with a long rectal pouch of 50–60 mm between 2009 and 2011 were used as control group. Data were collected including demographics, laparoscopic technique, operative time, stool frequency, complications and continence outcomes.
The operative time in MLDP group was significantly shorter than control group (3.0 h vs. 4.7 h, p = 0.02). The incidence of postoperative HAEC in MLDP group was lower than control group (12.5% versus 42.9%; p = 0.03) within the second postoperative year. Two patients (28.6%) experienced episodes of pouchitis in CLDP group and none was found in MLDP group. There was no significant difference in overall functional outcome between two groups, but the performance of MLDP group was better in terms of diapers required than CLDP group (1.80 ± 0.45 vs. 1.00 ± 0.64; p = 0.02). All patients after 4 years of age had a normal defecation frequency in both groups.
MLDP is a safe, simple, and reliable technique for TCA. It has fewer postoperative complications due to the short rectal pouch. However, longer follow-up and a larger sample size are necessary to prove the efficacy in the treatment of TCA.
Level 3.
Health-Related Quality of Life in Colon and Rectal Disease
2011, Seminars in Colon and Rectal Surgery
Citation Excerpt :
One of the founding fathers of HD surgery, Orval Swenson, creator of the eponymous procedure, reported in a 40-year retrospective, multinational study that 90-94% of Swenson procedure patients reported normal bowel habits and that these improved over time.42 Similarly, Dr Soave, creator of his own eponymous procedure, reported an 88% patient satisfaction rate on long-term follow-up,43 and Livaditis reported that 82% of their Duhamel patients reported normal bowel movements.44 Most recently, Suita and colleagues evaluated 99 patients with HD after repair with a mean follow-up of 16 years.
Health-related quality of life is increasingly recognized as an important factor in evaluating the impact of a disease on an individual or assessing the risks and benefits of a treatment. Investigators have developed numerous instruments that aim to assess global quality of life and disease-specific quality of life. Colorectal cancer, inflammatory bowel disease, and Hirschsprung's disease are 3 colorectal conditions that have been the subject of much quality of life-related investigation. In addition to symptomatology, patients' social support structures, expectations, and level of communication with caregivers are all factors that impact an individual's perceived quality of life in colorectal disease.
Early adult outcome of the Duhamel procedure for left-sided Hirschsprung disease-a prospective serial assessment study
2007, Journal of Pediatric Surgery
Citation Excerpt :
Short- and medium-term functional outcome data after surgery for Hirschsprung disease have been reported for a variety of procedures. Outcome studies in adults are rare because of the intrinsic difficulties of long-term follow-up [1,2]. However, several cross-sectional single-observation outcome studies (that include some adults) support the contention that bowel function improves with increasing age [3-10].
To assess both early adult functional outcome and change in long-term functional outcome over time after the Duhamel procedure (DP) for left-sided Hirschsprung disease (HSCR).
The study population consisted of 78 children (aged 19.9 ± 3.6 years) who previously underwent objective outcome assessment after DP was performed for HSCR during the period of 1980 to 1991. Inclusion criteria were previous evaluation of functional outcome and either rectosigmoid or left-sided HSCR. Outcome measures were assessed twice within the cohort, in 1997 and in 2005. The primary outcome measure was the Rintala (J Ped Surg. 1995;30:491-494) functional outcome score (FOS; maximum, 20). Controls consisted of 20 age-matched healthy children. Satisfactory functional score was defined as an FOS at or above the 10th percentile of controls (FOS, ≥17). Secondary outcome measures were the operation failure rate (defined by requirement for a stoma or major reoperative surgery), and enterocolitis rates (defined by intention to treat). Consecutive outcome scores were compared by paired t test. Data were expressed as mean ± SD, and P < .05 was considered significant.
Operation failure occurred in 9 (11.5%) of 78. Consecutive FOSs were obtained in 40 (57%) of 69. A satisfactory functional score was observed in 23 (58%) of 40 adults as opposed to 33 (47%) of 70 children 8 years previously (P = .02). Satisfactory outcome (defined by satisfactory functional score and lack of enterostomy or major revision pull-through procedure) was observed in 23 (47%) of 49. Previously, this figure was 34 (44%) of 78. Individual paired FOSs showed a significant improvement with time (1997: 14.9 ± 4.1; 2005: 16.4 ± 2.8; P = .02).
At early adult follow-up, the operation failure rate has not changed from that of the same cohort 8 years earlier. However, a significant improvement in individual FOSs was demonstrated.
Results of a mechanical Duhamel pull-through for the treatment of Hirschsprung's disease and intestinal neuronal dysplasia
2004, Journal of Pediatric Surgery
The authors analyzed the results of a modified entirely mechanical Duhamel pull-through for the treatment of Hirschsprung’ disease or type B intestinal neuronal dysplasia. The aim of the follow-up was to evaluate results of a Duhamel procedure entirely performed with the use of staplers.
Fifty-six patients were followed up to detect complications and outcome. Patients were evaluated clinically, and, when symptoms were present, a suction biopsy with histochemical analysis, an x-ray contrast enema, or an endoscopy was performed.
Early complications developed in 4 cases (7%) including a case of leakage (1.8%). No patient experienced recurrence. During a mean follow-up of 49 months, further complications occurred in 16 other patients: 4 adhesive obstructions requiring surgery, 3 strictures, 5 chronic bleeding, 4 fecaloma formation, 2 urinary problems, and 13 postoperative enterocolitis.
Four patients (7%) had more than 3 passages of liquid stools per day, and 3 of them who had an ileal pull-through had constant soiling. Thirty-seven children (68.5%) had 1 to 2 bowel movements per day and were continent. Seven (13%) had less than 3 bowel movements per week. Three children who underwent total colectomy were incontinent (5.5%). Three more children (5.5%) have not yet reached the age for continence. Forty-nine parents (87%) judged the outcome satisfactory.
Follow-up of mechanical Duhamel pull-through showed an acceptable long-term outcome. An increased risk of incontinence is present in case of ileal pull-through, whereas constipation is more frequent after partial colon resection, regardless of the type of intestinal neuronal malformation.
Life after definitive treatment for children with Hirschsprung's disease
2004, International Journal of Surgery
The aim of this study was to investigate the long-term outcomes after definitive surgical correction for children with Hirschsprung's Disease (HD) and the psychosocial impact HD has on the child and family.
A clinical-based database of seventy-two children and young people aged between one to twenty-fours years with HD, along with their families were investigated. This study involved the development of a condition-specific questionnaire in order to assess the functional and psychosocial outcomes for children with HD at different age groups, combined with parental perception of their child's condition in the long-term.
The greatest functional problem after definitive surgery for HD was faecal soiling (n = 29/38: 76.3%). Children ≤12 years experienced more embarrassment, distress/discomfort and family difficulties (n = 53/72; 73.6%) due to bowel dysfunctioning (such as faecal soiling) in comparison to children >12 years (n =19/72; 26.3%) (p < 0.05). Young adults with HD (>12 years) remained confident and 62.5% hopeful about their future with HD. Nine (12.5%) of the parents reported that HD had a negative impact on their marital relationship due to the daily stressors. Yet, 58.3% (n = 42) families remain confident and 70.8% (n = 42) hopeful about their child's future with HD.
Bowel functioning and psychosocial distress improves with increasing age and parental and medical professional support. Psychosocial difficulties found in the child and family with HD are condition-specific - thus improving complications such as faecal soiling will further enhance better psychosocial adjustment.
Long-term results of treatment of Hirschsprung's disease
2004, Seminars in Pediatric Surgery
Many children with Hirschsprung’s disease (HD) have a good outcome following surgical treatment, but long-term follow-up studies have identified a number of concerns. Analysis of long-term function in children after surgical management is difficult. The most commonly encountered problems include constipation, incontinence, enterocolitis and the overall impact of the disease on lifestyle (quality of life). Other complications are less frequent. Each of these problems will be discussed.

View all citing articles on Scopus

¹: From the Department of Pediatric Surgery, Karolinska Sjukhuset, Stockholm, Sweden.

View full text

Hirschsprung's disease: Long-term results of the original duhamel operation

J Pediatr Surg

J Pediatr Surg

Une nouvelle opération pour le mégacôlon congénital: L'abaissement rétro-rectal et trans-anal du côlon et son application possible au traitement de quelques autres malformations

Presse Med

New techniques in the surgical treatment of Hirschsprung's disease

Surgery

A method for elimination of the blind rectal pouch in the Duhamel operation for Hirschsprung's disease

Surgery

Evaluation of modified Duhamel operation for correction of Hirschsprung's disease

Ann Surg

Duhamel's operation for Hirschsprung's disease

Arch Surg