Long-term outcome and colonic motility after the Duhamel procedure for Hirschsprung's disease

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.