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 disease (HD) in children operated by laparoscopy and to highlight the occurrence of late enterocolitis in the postoperative outcome. The video shows the tips and tricks about laparoscopic Duhamel procedure and an example of Crohn-like ulcerations. ^{1 –24}

Patients and Methods:

Retrospective data collection from a single center from 1991 to 2013 concerned patients with extended forms of HD who underwent a laparoscopic Duhamel procedure and included extension of aganglionosis, comorbidities, short and mid postoperative outcome, and results of endoscopy.

Results:

A total of 30 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), and underwent a laparoscopic Duhamel procedure. 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 4 years (range: 6 months–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): six with ileum involvement and one extended to the transverse colon. Endoscopy showed perianastomosis longitudinal Crohn-like ulcerations in 100% of these cases. The mean delay between surgical procedure and ulceration diagnosis was 3.7 years (range 1–8 years). Three patients required redo ileostomy for recurrent abdominal distension, weight loss, and impaired growth.

Conclusion:

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's disease still requires to be investigated.

No competing financial interests exist.

Runtime of video: 9 mins 17 secs