Duhamel procedure: a comparative retrospective study between an open and a laparoscopic technique.
BACKGROUND
Few studies are available comparing open with laparoscopic treatment of Hirschsprung's disease. This study compares a laparoscopic series of 30 patients with a historical open series of 25 patients.


METHODS
The charts of all patients having had a Duhamel procedure in the period from June 1987 through July 2003 were retrospectively reviewed. Open procedures were performed until March 1994. Patients with extended aganglionosis, pre-Duhamel ostomy, or syndrome were excluded from the study. End points were intraoperative complications, postoperative complications, time to first feeding, hospital stay, and outcome at follow-up such as stenosis, enterocolitis, constipation, fecal incontinence, and enuresis.


RESULTS
Twenty-five patients had an open Duhamel (OD) and 30 had a laparoscopic one (LD). There were no differences in patient characteristics and there were no intraoperative complications in either group. Time to first oral feeds was significantly longer in the OD group as was the duration of hospital stay. No significant differences at follow-up were observed but there was a tendency for a higher enterocolitis rate in the LD group. In contrast, the adhesive obstruction and enuresis rates were higher in the OD group. Cosmetic results were superior in the LD group.


CONCLUSIONS
Except for a significantly shorter hospital stay and shorter time to first oral feeds in favor of LD, no significant differences could be observed. The cosmetic result was not an end point but there was no doubt that it was better in the LD group. Although not statistically significant different, there were no adhesive bowel obstructions in the LD group compared with 3 of 25 in the OD group. Fecal incontinence was not encountered in either group.
Travassos
D Vieira
DV
Department of Pediatric Surgery, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, The Netherlands. D.Vieira-Travassos@umcutrecht.nl
Bax
N M A
NM
Van der Zee
D C
DC
D002648:Child; D002675:Child, Preschool; D013505:Digestive System Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D004435:Eating; D004760:Enterocolitis / Q000453:epidemiology / Q000209:etiology; D004775:Enuresis / Q000453:epidemiology / Q000209:etiology; D004954:Esthetics; D005260:Female; D005500:Follow-Up Studies; D006627:Hirschsprung Disease / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D007415:Intestinal Obstruction / Q000453:epidemiology / Q000209:etiology; D010535:Laparoscopy / Q000009:adverse effects; D007902:Length of Stay; D008297:Male; D011184:Postoperative Period; D012189:Retrospective Studies; D013997:Time Factors