Radiological evaluation of Duhamel's operation in Hirschsprung's disease. Attempt at radio-clinical correlation.
The aim of this study was to evaluate the results of the Duhamel cure technique in a case of Hirschsprung's disease with a barium colorectal opacification by low approach. The overall height of the rectal stump (HR), the depth of the blind part of the rectum (PR), the rectal diameter (DR), the diameter of the colorectal anastomosis (DA) were measured. The rectal volume of its blind part (VRB), the rectal volume of its functional part (VRF), the surface of the colorectal and subanal anastomosis, the VRF/VRB ratio were calculated. Two types of subgroups were analysed: -the patients in whom the rectal stump had been closed by stapling (13 cases) and those where the rectal stump was manually closed (13 cases). -the patients who had no transit trouble (20 cases) and those in whom a stercoroma or coproma had formed, including phenomena either similar to encopresia or to soiling. The manual suture of the top of the rectal stump does not show any significant difference compared to stapling. The rectal height (HR=71 mm+/-1.9), the blind rectal stump depth (PR = 36 mm+/-2.2) of the 6 patients with stercoroma are significantly higher than with the other 20 patients (HR = 51.6+/-2.6 and PR = 24.4+/-2.7, i.e. respectively p = 0.0005 and p = 0.03). VRF and VRB are equal in the group with stercoroma, and VRF is twice or more than VRB in the group without any problem. If it is impossible to obtain a sufficiently short rectal pouch, an excessive HR may be balanced by a longer colorectal anastomosis with a higher VRF/VRB ratio. This is of importance in laparoscopic procedure.
Becmeur
F
F
Service de Chirurgie Infantile, Hôpitaux Universitaires de Strasbourg, France. Francois.Becmeur@chru-strasbourg.fr
Moog
R
R
De Luca
G
G
Christmann
D
D
Sauvage
P
P
D001466:Barium Sulfate; D004733:Enema; D006627:Hirschsprung Disease / Q000000981:diagnostic imaging* / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy; D011183:Postoperative Complications / Q000517:prevention & control; D016737:Proctocolectomy, Restorative / Q000379:methods*; D011859:Radiography; D012002:Rectal Diseases / Q000517:prevention & control; D013536:Suture Techniques
D001466:Barium Sulfate