title: Long-Term Outcome of Laparoscopic Duhamel Procedure for Extended Hirschsprung's Disease.
abstract: BACKGROUND
  The aim of our study was to report our experience in extended Hirschsprung's disease (HD) in children operated on by laparoscopy.
  
  
  METHODS
  Retrospective data collection from a single center from 1991 to 2013 concerned extended forms of HD operated on by laparoscopic Duhamel procedure and included extension of aganglionosis, comorbidities, short and late postoperative outcome, and results of endoscopy when performed.
  
  
  RESULTS
  Thirty patients presented an extended form of aganglionosis: 5 involving the transverse colon, 10 the right colon, and 15 the ileum (median length = 15 cm, range 1-60). Short-term outcome showed 13% postoperative complications requiring redo-surgery: occlusion (n = 2), wall abscess (n = 1), and anastomotic leak (n = 1). Median follow-up was of 5 years (range: 1-19 years). Satisfying bowel control was reached in 53%, and 46% had a weight-for-age reference curve up to -1 SD. They had four stools per day on average, 13% of soiling, 6% of constipation, and 26% of recurrent abdominal distention. Late enterocolitis occurred in 22% (n = 7): 6 with ileum involvement and 1 extended to the transverse colon. Endoscopy showed Crohn-like ulcerations in 100% of these cases.
  
  
  CONCLUSIONS
  Laparoscopic Duhamel procedure is a safe and effective surgical technique in the management of extended forms of HD, with a low postoperative morbidity, but the frequent occurrence of late enterocolitis associated with Crohn-like ulcerations impairs the late outcome. Link between HD and Crohn disease still requires to be investigated.
authors.affiliation: 1 Department of Pediatric Surgery, Hôpital Robert Debré , APHP, Paris, France .
authors.forename: Cécile O
authors.initials: CO
authors.lastname: Muller
authors.affiliation: 1 Department of Pediatric Surgery, Hôpital Robert Debré , APHP, Paris, France .
authors.forename: Guillaume
authors.initials: G
authors.lastname: Rossignol
authors.affiliation: 1 Department of Pediatric Surgery, Hôpital Robert Debré , APHP, Paris, France .
authors.forename: Louise
authors.initials: L
authors.lastname: Montalva
authors.affiliation: 2 Pediatric Gastroenterology, Hôpital Robert Debré , APHP, Paris, France .
authors.forename: Jerome
authors.initials: J
authors.lastname: Viala
authors.affiliation: 2 Pediatric Gastroenterology, Hôpital Robert Debré , APHP, Paris, France .
authors.forename: Christine
authors.initials: C
authors.lastname: Martinez-Vinson
authors.affiliation: 2 Pediatric Gastroenterology, Hôpital Robert Debré , APHP, Paris, France .
authors.forename: Alexis
authors.initials: A
authors.lastname: Mosca
authors.affiliation: 3 Department of Pathology, Hôpital Robert Debré , APHP, Paris, France .
authors.forename: Dominique
authors.initials: D
authors.lastname: Berrebi
authors.affiliation: 1 Department of Pediatric Surgery, Hôpital Robert Debré , APHP, Paris, France .
authors.forename: Arnaud
authors.initials: A
authors.lastname: Bonnard
mesh_terms: D057868:Anastomotic Leak / Q000453:epidemiology / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D044682:Colon, Ascending / Q000601:surgery*; D044684:Colon, Transverse / Q000601:surgery*; D003248:Constipation / Q000453:epidemiology; D003424:Crohn Disease; D013505:Digestive System Surgical Procedures / Q000379:methods*; D004760:Enterocolitis / Q000453:epidemiology; D005242:Fecal Incontinence / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006627:Hirschsprung Disease / Q000601:surgery*; D006801:Humans; D007082:Ileum / Q000601:surgery*; D007223:Infant; D010535:Laparoscopy / Q000379:methods; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology*; D011184:Postoperative Period; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000601:surgery; D016896:Treatment Outcome
keywords: Duhamel procedure; Hirschsprung's disease; laparoscopy