One-stage Duhamel-Martin procedure for Hirschsprung's disease: a 5-year follow-up study.

摘要

BACKGROUND/PURPOSE: With the introduction of the Endo-GIA stapling device the 1-stage Duhamel-Martin procedure became feasible for neonates and infants. Early results were promising. So far there were no meaningful data on the long-term functional results. This study shows the 5-year follow-up results after 1-stage Duhamel-Martin procedure for Hirschsprung's disease in neonates and infants. The results are compared with a historical group of patients from the same institution undergoing a 3-stage procedure. METHODS: Between September 1991 and December 1993 Hirschsprung's disease was diagnosed in 29 children. In 22 of them the disease was found within the first 2 months of life. In 19 children aganglionosis was restricted to the rectosigmoid colon. In 10 the innervation disturbance extended further, twice with involvement of the distal ileum. Initial treatment consisted of daily rectal irrigation. Postoperative follow-up on a regular out-clinic basis was 6 years (range, 5 to 7 years). Patients were scored for fecal continence, soiling, the use of laxatives, cannulae or rectal irrigation, enterocolitis, gain of body weight, and length. RESULTS: There were no intraoperative complications. The median postoperative stay was 7.7 days. Seven children encountered complications for which admission was necessary. Ultimately, 15 children have normal spontaneous defecation. Eight children display irregular soiling, without using laxatives. At 5-year follow-up 6 children are still on some sort of laxative or rectal irrigation. Mean growth and body weight is along the P50 and P50 to 90, respectively. These functional results are no different from those in the patients after 3-stage Duhamel-Martin procedure. CONCLUSIONS: There appears to be no difference in functional outcome after 1- or multiple-stage Duhamel-Martin procedure for Hirschsprung's disease after 5 to 7 years. The majority of children seem to fare well with restrictive need of laxatives. The advantage of a 1-stage procedure is the prevention of stoma-related complications, 1 or 2 additional operations, and extra scar formation.