Ct. Baillie et al., Long-term outcome and colonic motility after the Duhamel procedure for Hirschsprung's disease, J PED SURG, 34(2), 1999, pp. 325-329
Background/Purpose: The aim of this study was to investigate long-term func
tional outcome and colonic motility in children who had undergone the Duham
el-type operation for Hirschsprung's disease (HSCR).
Methods: All patients (n = 91) who underwent the Duhamel or Lester Martin M
odified Duhamel operation for HSCR from 1980 to 1991 were included in the s
tudy. Twenty-two healthy age-matched children were used as controls. Functi
onal outcome was assessed by questionnaire (response rate 100%). Total and
segmental colonic transit time (CTT) was determined using the saturation me
thod (80% participation rate).
Results: Outcome scores were significantly worse in the study group far pat
ients with rectosigmoid (RS, P < .001), long segment (LS, P < .001), and to
tal colonic (TC) aganglionosis (P < .05), when compared with controls. The
CTT was significantly prolonged in the RS group (P = .01) compared with LS,
TC, and control groups; this was caused by prolonged "rectosigmoid" transi
t in the RS group compared with controls (P = .012). There was a positive l
inear correlation (P = .0002) between age and outcome score in patients wit
h RS disease unrelated to CTT. Nine patients required a late long-term ente
rostomy. A satisfactory outcome (defined as outcome score greater than or e
qual to 10th percentile of the control group, and absence of stoma or requi
rement for major revisional surgery) was seen in only 42% of patients overa
ll and in 79% of patients over 14 years of age.
Conclusions: The Duhamel procedure, in com mon with other pull-through proc
edures, is associated with significant longterm morbidity, the aetiology of
which is poorly understood. J Pediatr Surg 34:325-329. Copyright (C) 1999
by W.B. Saunders Company.