A NEW LOOK AT AN OLD OPERATION FOR AGANGLIONOSIS

Since 1980, the authors have operated on seven infants with total colo n Hirschsprung's disease using the long Duhamel procedure. All infants were given an ileostomy when the diagnosis was made, and the long Duh amel procedure was performed between 6 and 24 months of age. This oper ation is the standard Duhamel procedure except that the sigmoid and de scending colon form the fecal reservoir (as in the Martin variation of the Duhamel operation). A covering loop ileostomy was made in all the patients, and it was closed within 5 months; two infants had one epis ode of enterocolitis, 1 to 9 months after closure. The seven infants h ave had follow-up for 1 to 13 years; all are alive and well. The child ren are continent and toilet trained (age not withstanding); they have up to 10 formed stools per day. Two had some soiling at night. Wherea s in the past the Duhamel procedure lin which a too-long anterior rect al pouch was left) often resulted in the formation of a fecal impactio n, this does not occur when the material passing through the anus is a t best semiliquid. With no long side-to-side anastomosis. the procedur e is simple and complications are few. Copyright (C) 1994 by W.B. Saun ders Company