Laparoscopic Duhamel Procedure: Management of 55 Cases

Abstract

Introduction

: Hirschprung disease (HD) is a common cause of neonatal intestinal obstruction and chronic constipation. Advances in instrumentation and in laparoscopic experience have made laparoscopic correction possible in recent years.

Methods

: Medical records of children who underwent a laparoscopic Duhamel (LD) procedure from February 1995 to June 2002 in our institution were reviewed. Operative technique was always the same, using 4 ports (5, 5, 10, and 12 mm) and wall suspension. We recorded birth weight, clinical features, age and weight at procedure, morbidity, and followup.

Results

: Fifty-five children, 46 boys and 9 girls, with a median birth weight of 3046 g, were operated on. They ranged in age from 25 days to 8 years (mean, 13 months). Four cases of enterocolitis and 16 cases of sepsis necessitated 20 colostomies and 5 ileostomies (total colonic aganglionosis). Average operative time was 140 minutes (range, 100–330 minutes). Four conversions were necessary. There were no deaths. There was 1 anastomosis leakage (colostomy and Swenson 6 months later), 1 retrorectal abscess (local drainage), and 1 ileal perforation during total colectomy (ileostomy). Postoperative complications included 2 cases of urinary infection and 1 blood sepsis. There were no cases of enterocolitis and no anastomosis stenosis. Followup, ranging from 3 months to 7 years, found 40 excellent results, 6 resections of spur, and 8 children with persisting constipation requiring laxative.

Conclusion

: LD is feasible in cases of left, right, or total colonic aganglionosis. There were excellent early and late results, similar to those in the open technique, without adhesions and scars.