Duhamel-Sulamaa operation for Hirschsprung's disease--early and late results in forty-eight patients.

The Sulamaa modification of the Duhamel procedure and the early and late results of the first 48 patients are reported. A specially devised clamp is used in the colorectal side-to-side anastomosis with no intra-abdominal or intrapelvic anastomoses being required. There were no mortality and no anastomotic leaks among the patients. A postoperative septum between rectum and the pull-through segment developed in 35% of the patients. Soiling and, in some cases, constipation, were the main symptoms of septum formation. These problems ceased after reclamping of the septum. At the last follow-up, 2 to 15 years after surgery, 37 patients had normal bowel habits, 4 had occasional soiling and 7, six of whom are mentally retarded, daily soiling. None of the children had constipation. The Duhamel-Sulamaa operation gives satisfactory long-term results in the treatment of Hirschsprung's disease. Septic anastomotic complications appear to be avoidable with this technique, but the significant frequency of postoperative septum formation requires close early follow up of the operated patients.