title: Outcome comparison among laparoscopic Duhamel, laparotomic Duhamel, and transanal endorectal pull-through: a single-center, 18-year experience.
abstract: OBJECTIVE
  Transanal endorectal pull-through has changed the treatment of Hirschsprung's disease (HD) in the past decade. The aim of the study was to compare outcomes, obtained in a single center, with laparotomic Duhamel (LTD), laparoscopic Duhamel (LSD), and laparoscopic-assisted transanal endorectal pull-through (LTEPT).
  
  
  METHODS
  We retrospectively reviewed the charts of all patients operated on for HD since 1992. Preoperative, operative, and postoperative data were collected to compare short- and long-term outcomes among the three groups.
  
  
  RESULTS
  From 1992 to 2010, 70 children were treated for HD. Patients were divided into three groups based on the surgical technique used: 14 LTEPT, 32 LSD, and 24 LTD. Mean ages at surgery were 4.67, 14.61, and 13.28 months, respectively. Patients in the LTEPT group had significant shorter operating times (195 versus 257 versus 291 minutes, P=.03), earlier start of feeding (1.2 versus 3.1 versus 4.7 days, P<.01), and shorter length of hospital stay (4.4 versus 6.8 versus 9.7 days, P<.011). Overall complications rate was lower in the LTEPT (14%) than in the LSD (31.2%) and LTD (29.7%) groups. Postoperative enterocolitis incidence was 3%-4% in the Duhamel groups and none in LTEPT. Long-term outcome showed less constipation and better continence for age in the LTEPT group at the 1-year follow-up (P=.033).
  
  
  CONCLUSIONS
  This study further supports technical advantages, lighter impact of the surgical procedure on infants, lower incidence of complications, and better long-term outcome of the transanal pull-through compared to the Duhamel approaches.
authors.affiliation: Division of Pediatric Surgery, Department of Pediatrics Salus-Pueri, University of Padova, Padova, Italy. stegiuliani@hotmail.com
authors.forename: Stefano
authors.initials: S
authors.lastname: Giuliani
authors.forename: Pietro
authors.initials: P
authors.lastname: Betalli
authors.forename: Alessandra
authors.initials: A
authors.lastname: Narciso
authors.forename: Francesca
authors.initials: F
authors.lastname: Grandi
authors.forename: Paola
authors.initials: P
authors.lastname: Midrio
authors.forename: Guendalina
authors.initials: G
authors.lastname: Mognato
authors.forename: Piergiorgio
authors.initials: P
authors.lastname: Gamba
mesh_terms: D001003:Anal Canal; D013505:Digestive System Surgical Procedures / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006627:Hirschsprung Disease / Q000601:surgery*; D006801:Humans; D007223:Infant; D010535:Laparoscopy; D007813:Laparotomy; D007902:Length of Stay; D008297:Male; D011183:Postoperative Complications; D012189:Retrospective Studies; D016896:Treatment Outcome