From the Research
Hirschsprung disease should be treated with a laparoscopic Duhamel procedure, as it has been shown to have superior outcomes compared to open Duhamel procedures, with reduced incidence of soiling, incontinence, and further surgery, as well as shorter hospital stays and time to oral feed. This is based on the most recent and highest quality study available, which compared long-term outcomes for open Duhamel and laparoscopic Duhamel procedures for Hirschsprung's disease 1. The study found that the laparoscopic group had a significantly lower incidence of soiling and incontinence, as well as reduced need for further surgery, compared to the open group.
Key Points
- Hirschsprung disease is a congenital disorder characterized by the absence of nerve cells in the wall of the colon, resulting in intestinal obstruction.
- Treatment primarily involves surgical intervention to remove the affected segment of bowel.
- The main surgical approach is a pull-through procedure, where the abnormal segment is removed and the healthy bowel is connected to the anus.
- Laparoscopic Duhamel procedure is the recommended surgical approach, due to its superior outcomes compared to open Duhamel procedures.
- Early diagnosis is crucial and typically involves rectal biopsy to confirm the absence of ganglion cells.
Surgical Management
- The laparoscopic Duhamel procedure involves a minimally invasive approach, with reduced risk of complications and faster recovery times.
- The procedure typically involves a single stage, but may be performed in two stages depending on the patient's condition.
- Temporary measures, such as rectal irrigations or a temporary ostomy, may be used to decompress the bowel before surgery.
Postoperative Care
- Patients typically have good outcomes after surgery, but may experience ongoing issues with constipation or incontinence requiring long-term management.
- Close follow-up and monitoring are necessary to ensure optimal outcomes and address any potential complications.
- The laparoscopic Duhamel procedure has been shown to have reduced incidence of postoperative complications, such as enterocolitis and anastomotic leakage, compared to open Duhamel procedures 1.