Modified Duhamel Retrorectal Pull-Through for Hirschsprung’s Disease
Shafiq ur Rehman, Muhammad Anwar, Zarlish Fazal
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ABSTRACT
Objectives: To
evaluate the post-operative complications and short-term outcomes of modified
Duhamel retrorectal pull-through procedure for Hirschsprung’s disease.
Design: Prospective
descriptive study
Place and Duration of Study: Department of Paediatric Surgery Sahiwal Teaching Hospital Sahiwal from 1stJanuary
2018 to 31st December 2020.
Methodology: Thirty seven histologically confirmed cases of Hirschsprung’sdisease having previous
decompressing colostomy/stoma age between 1 to 12 years of agewere included.
Children under one year of age, with sever comorbidities like Down syndrome and
cardiac abnormalities, and those who require re-do pull through procedure were
excluded. Modified Duhamel retrorectal pull-through procedure was performed in
all cases. The demographic information included age, sex, proximal level of
aganglinosis, complications of definite procedure, length of hospitalization
andmortality. Other information recorded included long term complications like
obstructive symptoms, enterocolitis, incontinence and soiling at follow up.
Krickenbeck classification was used to evaluate faecal incontinence and
constipation. Kelly’s clinical score was used to assess the anal sphincter.
Bowel habits were assessed only in children above three years of age.
Results: Twenty six (70.27%) were males and 11 (29.72%) females with male to female ratio
2.3:1 and mean age at operation was 2.89±1-9 years. Twenty nine (78.37%) children were ≤3 years of age and 8 (21.62%) were
>3 years. Mean weight was 12.91 kgs, operation time was 126.81 time, fasting
time was 6.67 days and hospital stay was 11.91 days. Length of aganglionic
segment was short segment 27 (72.97%), long segment 9 (24.32%) and total
colonic 1 (2.7%). Hirschsprung associated enterocolitis 7 (18.91%) and wound
infection 6(16.21%) were most common reported complications. Constipation in
5(13.51) and soiling with retentive constipation was present in 3 (8.10%)
patients. Out of total 31 patients who reached toilet training age, 28 (90.32%)
developed satisfactory voluntary bowel habits.
Conclusion: Modified
Duhamel pull-through procedure was found to be safe, applicable and with lower
associated complications and satisfactory short term functional outcomes in our
settings.
Key words: Hirschsprung’s
disease, Modified Duhamel pull-through procedure, Complications, Outcomes