LONG-TERM ANORECTAL FUNCTION AFTER DUHAMEL OPERATION FOR HIRSCHSPRUNGS-DISEASE

Long-term anorectal function was assessed in children operated on usin g Duhamel's technique for Hirschsprung's disease. The files of 75 pati ents (16 girls and 59 boys) operated on between 1977 and 1991 were rev iewed. Questionnaires were analysed on 63 (12 girls and 51 boys) over 2 years of age, The median age at completing the questionnaire was 6.6 years. Forty-one of these 63 patients had aganglionosis of the rectos igmoid, 15 of a long colonic segment, and 7 of the total colon. Of 14 children age 4 or less, 6 had severe constipation, whereas 8 had regul ar spontaneous defaecation. Ten of the 49 over 4 years of age were con tinent without constipation, 22 had soiling and/or constipation, and 1 7 were incontinent, one of whom had a permanent colostomy. There was n o correlation between age or sex and anorectal function. Anorectal fun ction in children with long segment was not worse than in those with r ectosigmoid aganglionosis, but only 1 of 7 with total colonic aganglio nosis was continent. Because many adapt themselves to the handicap, sy mptoms are often underreported. A detailed questionnaire appears to be a reliable tool for elucidating the real situation. A systematic foll ow up of patients with Hirschsprung's disease is proposed to anticipat e the complications and to institute proper measures at an early stage . Copyright (C) 1995 by W.B. Saunders Company