Results of a mechanical Duhamel pull-through for the treatment of Hirschsprung's disease and intestinal neuronal dysplasia.
OBJECTIVE
The authors analyzed the results of a modified entirely mechanical Duhamel pull-through for the treatment of Hirschsprung' disease or type B intestinal neuronal dysplasia. The aim of the follow-up was to evaluate results of a Duhamel procedure entirely performed with the use of staplers.


METHODS
Fifty-six patients were followed up to detect complications and outcome. Patients were evaluated clinically, and, when symptoms were present, a suction biopsy with histochemical analysis, an x-ray contrast enema, or an endoscopy was performed.


RESULTS
Early complications developed in 4 cases (7%) including a case of leakage (1.8%). No patient experienced recurrence. During a mean follow-up of 49 months, further complications occurred in 16 other patients: 4 adhesive obstructions requiring surgery, 3 strictures, 5 chronic bleeding, 4 fecaloma formation, 2 urinary problems, and 13 postoperative enterocolitis. Four patients (7%) had more than 3 passages of liquid stools per day, and 3 of them who had an ileal pull-through had constant soiling. Thirty-seven children (68.5%) had 1 to 2 bowel movements per day and were continent. Seven (13%) had less than 3 bowel movements per week. Three children who underwent total colectomy were incontinent (5.5%). Three more children (5.5%) have not yet reached the age for continence. Forty-nine parents (87%) judged the outcome satisfactory.


CONCLUSIONS
Follow-up of mechanical Duhamel pull-through showed an acceptable long-term outcome. An increased risk of incontinence is present in case of ileal pull-through, whereas constipation is more frequent after partial colon resection, regardless of the type of intestinal neuronal malformation.
Mattioli
Girolamo
G
Department of Pediatric Surgery, Giannina Gaslini Research Institute, University of Genova, Genova, Italy.
Castagnetti
Marco
M
Martucciello
Giuseppe
G
Jasonni
Vincenzo
V
D000015:Abnormalities, Multiple; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003082:Colectomy / Q000379:methods; D017615:Enteric Nervous System / Q000002:abnormalities*; D004760:Enterocolitis / Q000453:epidemiology; D005242:Fecal Incontinence / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006471:Gastrointestinal Hemorrhage / Q000453:epidemiology; D006627:Hirschsprung Disease / Q000601:surgery*; D006801:Humans; D007082:Ileum / Q000601:surgery; D007223:Infant; D007422:Intestines / Q000002:abnormalities / Q000294:innervation*; D008297:Male; D017060:Patient Satisfaction; D011183:Postoperative Complications / Q000453:epidemiology / Q000601:surgery; D020182:Sleep Apnea, Central / Q000150:complications; D017792:Surgical Stapling; D000267:Tissue Adhesions / Q000453:epidemiology / Q000601:surgery; D016896:Treatment Outcome