PRINCIPAL MODIFICATIONS OF THE DUHAMEL PROCEDURE IN THE TREATMENT OF HIRSCHSPRUNGS-DISEASE - ANALYSIS BASED ON RESULTS OF AN INTERNATIONAL RETROSPECTIVE STUDY OF 2,430 PATIENTS

In the literature, many articles refer to the DUHAMEL technique or som e of its modifications in the treatment of Hirschsprung's disease, how ever, no complete review of all of them has been published to date. Th e authors present an analysis of the principal modifications of this t echnique based on the results of an international retrospective survey that evaluated a series of 2,430 patients as well as data from the li terature. The important role of the internal anal sphincter in the phy siology of continence is emphasized; understanding its function is an imperative prerequisite for a successful Duhamel procedure. The origin al technique, which used two crushing Kocher clamps as proposed by Dun amel in 1956, as well as a majority of the modifications with various spur-crushing instruments are no longer in use. At present, surgeons g enerally use staplers for the colorectal anastomosis.