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CC BY-NC-ND 4.0 · Journal of Coloproctology 2023; 43(04): e271-e275
DOI: 10.1055/s-0043-1776891
Original Article

Assessment of Functional Outcome Following Duhamel Retro-Rectal Pull-Through Surgery for Hirschsprung's Disease - A Follow-up Study

Raghunath S. M.
1   Department of Pediatric Surgery, Institute of Child Health and Hospital for Children, Chennai, Tamil Nadu, India
,
Raghul Maniam
1   Department of Pediatric Surgery, Institute of Child Health and Hospital for Children, Chennai, Tamil Nadu, India
,
Vembar Dhanasekarapandian 
1   Department of Pediatric Surgery, Institute of Child Health and Hospital for Children, Chennai, Tamil Nadu, India
,
Hariharan Govindarajan
1   Department of Pediatric Surgery, Institute of Child Health and Hospital for Children, Chennai, Tamil Nadu, India
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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.

Keywords

Hirschsprung's disease - Duhamel procedure - bowel function score - constipation - pseudo-incontinence - MACE - Malone's antegrade colonic enemas


Publication History

Received: 08 August 2023

Accepted: 24 October 2023

Article published online:
27 November 2023

© 2023. Sociedade Brasileira de Coloproctologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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