Neonatal Duhamel's pull-through for Hirschsprung's disease.
BACKGROUND
Neonatal Duhamel's pull-through was compared with 2 other approaches to Hirschsprung's disease (HD) diagnosed in the neonatal period.


METHODS
Fifty HD patients, undergoing Duhamel's pull-through, were divided into 3 groups. Group I had 14 patients with neonatal pull-through; group II had 9 patients with delayed one-stage pull-through; and group III had 27 patients with two-stage pull-through. Operative bleeding and time, complications, and functional results were analyzed.


RESULTS
The operative bleeding and operative time were significantly more and longer in group III (p < 0.001). Post-operative enterocolitis and fecaloma occurred in 9 (18%) and 16 (32%) patients respectively, and neither of the complications were different among 3 groups (p = 0.826 and 0.868). The common wall of the rectal pouch in group I was eliminated by endo-GIA stapler in 11 patients, and clamp placement in 3. Of 4 patients of group I with fecaloma, only I used endo-GIA stapler. The functional results were good in 35 patients, with mild constipation in 15 and were not statistically different among 3 groups (p = 0.184).


CONCLUSIONS
HD on neonates can be successfully treated by Duhamel's pull-through in neonatal period using endo-GIA stapler. The functional results are as good as those with the delayed one-stage or two-stage Duhamel's procedure, with the child usually benefitting by not having home enema or stoma.
Liu
Chin-Su
CS
Division of Pediatric Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC. csliu@vghtpe.gov.tw
Chin
Tai-Wai
TW
Wei
Chou-Fu
CF
D013505:Digestive System Surgical Procedures / Q000379:methods*; D005260:Female; D006627:Hirschsprung Disease / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology