One-stage Duhamel-Martin procedure for Hirschsprung's disease: A 5-year follow-up study

Background/Purpose: With the introduction of the Endo-GIA stapling device t he 1-stage Duhamel-Martin procedure became feasible for neonates and infant s. Early results were promising. So far there were no meaningful data on th e long-term functional results. This study shows the 5-year follow-up resul ts after 1-stage Duhamel-Martin procedure for Hirschsprung's disease in neo nates and infants. The results are compared with a historical group of pati ents from the same institution undergoing a 3-stage procedure. Methods: Between September 1991 and December 1993 Hirschsprung's disease wa s diagnosed in 29 children. In 22 of them the disease was found within the first 2 months of life. In 19 children aganglionosis was restricted to the rectosigmoid colon. In 10 the innervation disturbance extended further, twi ce with involvement of the distal ileum. Initial treatment consisted of dai ly rectal irrigation. Postoperative follow-up on a regular out-clinic basis was 6 years (range, 5 to 7 years). Patients were scored for fecal continen ce, soiling, the use of laxatives, cannulae or rectal irrigation, enterocol itis, gain of body weight, and length. Results: There were no intraoperative complications. The median postoperati ve stay was 7.7 days. Seven children encountered complications for which ad mission was necessary. Ultimately, 15 children have normal spontaneous defe cation. Eight children display irregular soiling, without using laxatives. At 5-year follow-up 6 children are still on some sort of laxative or rectal irrigation. Mean growth and body weight is along the P50 and P50 to 90, re spectively. These functional results are no different from those in the pat ients after 3-stage Duhamel-Martin procedure. Conclusions: There appears to be no difference in functional outcome after 1- or multiple-stage Duhamel-Martin procedure for Hirschsprung's disease af ter 5 to 7 years. The majority of children seem to fare well with restricti ve need of laxatives. The advantage of a 1-stage procedure is the preventio n of stoma-related complications, 1 or 2 additional operations, and extra s car formation. J Pediatr Surg 35:1434-1436. Copyright (C) 2000 by W.B. Saun ders Company.