Clinical, manometric and profilometric evaluation after surgery for Hirschsprung's disease: comparison between the modified Duhamel and the transanal rectosigmoidectomy techniques.
OBJECTIVE
To evaluate fecal continence, anorectal manometry (AM) and profilometry (P), in patients operated for congenital megacolon, using either the modified Duhamel technique (MDT) or the modified transanal rectosigmoidectomy (MTR) technique.


METHODS
42 patients were evaluated clinically and via AM and P, for postoperative control. The resting, coughing, voluntary contraction, maintained voluntary contraction and perianal stimulation pressures were investigated. The rectosphincteric reflex was tested and the simple and enhanced pressure curves were evaluated. The three-dimensional profilometric outline was produced. Student's t, chi-squared and Fisher's exact tests were used for statistical analysis (p<0.05).


RESULTS
AM showed mean resting pressures of 53.44 mmHg for MDT and 60.67 mmHg for MTR, and mean voluntary contraction pressures of 94.50 mmHg for MDT and 95.47 mmHg for MTR. There was no statistical difference between the groups. The shapes of the simple and enhanced pressure curves did not present any statistical difference, independent of the surgical technique used.


CONCLUSIONS
The two surgical techniques were equivalent. MDT caused greater incidence of postoperative constipation that MTR did. AM and P were shown to be excellent tests for postoperative follow-up among these patients.
Division of Pediatric Surgery, Department of Surgery, UNIFESP, Sao Paulo, Brazil.
Elaine Cristina Soares
EC
Martins
Fábio Luis
FL
Peterlini
Djalma José
DJ
Fagundes
José Luiz
JL
Martins
D000293:Adolescent; D001003:Anal Canal / Q000033:anatomy & histology / Q000502:physiology / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D003248:Constipation / Q000209:etiology / Q000517:prevention & control*; D013505:Digestive System Surgical Procedures / Q000379:methods; D005242:Fecal Incontinence / Q000209:etiology* / Q000503:physiopathology; D005260:Female; D006627:Hirschsprung Disease / Q000601:surgery*; D006801:Humans; D007223:Infant; D008297:Male; D008365:Manometry; D011182:Postoperative Care; D011183:Postoperative Complications; D011312:Pressure; D012007:Rectum / Q000502:physiology / Q000601:surgery*; D016896:Treatment Outcome