Neonatal Duhamel's pull-through for Hirschsprung's disease.

BACKGROUND

Neonatal Duhamel's pull-through was compared with 2 other approaches to Hirschsprung's disease (HD) diagnosed in the neonatal period.

METHODS

Fifty HD patients, undergoing Duhamel's pull-through, were divided into 3 groups. Group I had 14 patients with neonatal pull-through; group II had 9 patients with delayed one-stage pull-through; and group III had 27 patients with two-stage pull-through. Operative bleeding and time, complications, and functional results were analyzed.

RESULTS

The operative bleeding and operative time were significantly more and longer in group III (p < 0.001). Post-operative enterocolitis and fecaloma occurred in 9 (18%) and 16 (32%) patients respectively, and neither of the complications were different among 3 groups (p = 0.826 and 0.868). The common wall of the rectal pouch in group I was eliminated by endo-GIA stapler in 11 patients, and clamp placement in 3. Of 4 patients of group I with fecaloma, only I used endo-GIA stapler. The functional results were good in 35 patients, with mild constipation in 15 and were not statistically different among 3 groups (p = 0.184).

CONCLUSIONS

HD on neonates can be successfully treated by Duhamel's pull-through in neonatal period using endo-GIA stapler. The functional results are as good as those with the delayed one-stage or two-stage Duhamel's procedure, with the child usually benefitting by not having home enema or stoma.