Modified duhamel's two-staged procedure for hirschsprung's disease: Further modifications for improved outcomes

• Published in: Journal of Indian Association of Pediatric Surgeons 2020-09, Vol.25 (5), p.269-275
• Main Authors: Peters, Nitin, Menon, Prema, N. Rao, K, Samujh, Ram
• Format: Article
• Language: English
• Subjects: Colorectal surgery; colostomy; contrast enema; hirschsprung's disease; modified duhamel procedure; Original; Ostomy; outcome analysis; Pediatrics; quality of life; Surgical outcomes
• ISSN: 0971-9261; 1998-3891
• DOI: 10.4103/jiaps.jiaps_55_19

Aims and Objectives: We studied the short- and long-term outcomes and quality of life (QOL) in patients undergoing a two-staged modified Duhamel's procedure for Hirschsprung's disease. Materials and Methods: Patients who had undergone this modified procedure, with initial Hartmann's procedure based on contrast enema, followed by bowel preparation and low colo-anal anastomosis below the dentate line were included. The patient who underwent this procedure over 10 years with a minimum 2-year follow-up were analysed based on an interview-based questionnaire. Results: Of the 152 patients, 69 responded. Mean age at the time of interview was 7.72 ± 3.04 years with mean follow-up of 4.9 years (2-11 years). Perineal excoriation and soiling was present in 60.9% and 36.2% of patients initially which reduced to 0 and 4.3% by the end of 2 years. In the first 6 months, postoperative period, 15.9% of patients had constipation and 78.2% had altered stool consistency. Good fecal continence score was present in 97.1% of patients in the long term. About 95.4% had good QOL scores. There was no mortality in this series. Conclusions: Although short-term outcomes showed altered bowel function, soiling, and perineal excoriation, this improved significantly in the long term, with good QOL scores in the majority.