Kifayat Khan.
Two stage management of patients with Hirschsprung`s disease.
J Surg Pak Jan ;10(4):7-12.

Objective: To find the outcome of Duhamel procedure in patients with Hirschsprung`s disease. Design of Study: Interventional study. Place and Duration of Study: At the Department of Paediatric Surgery PGMI / Lady Reading Hospital, Peshawar, from January 2003 to December 2004. Patients and Methods: Twenty patients with Hirschsprung`s disease managed over a period of 2 years were included. Diagnosis was established by barium enema and open rectal biopsy. Colostomy was dismantled in all patients and brought down as a pull through gut in a modified Duhamel procedure using a linear cutter (TLC-75). No colostomy cover was provided and the rectum was drained with a big size (30 Fr) flatus tube along with nasogastric suction for 2-3 days. Any complication encountered during the hospital stay was recorded. After discharge patients were followed up in the outpatient department and they were clinically assessed for constipation, diarrhoea, faecal continence etc. Results: There were 15 male and 05 female patients. Age ranged form 12 months to 05 years. All patients had sigmoid colostomy after confirmation with conventional rectal biopsy. There was no mortality in this study. Wound infection occurred in 05 patients. Persistent pyrexia and prolonged hospital stay for more than 10 days was seen in 02 patients. One patient developed incisional hernia while perineal excoriation developed in two patients. Recurrent diarrhoea and perineal soiling found in 02 and 01 patients respectively. All patients are thriving well with no case presenting with enterocolitis uptil now. There was not a single patient with anal stenosis needing anal dilatation. Conclusion: Two-stage correction of Hirschsprung`s disease is a safe procedure in all age groups. It is economical with social advantages to the parents, as the stage of colostomy closure is avoided with elimination of the possible complications associated with stoma and its closure. Utilization of the stoma to become part of the pull through gut gives an additional advantage of avoiding the need for frozen section biopsy, a facility which is lacking in our set up. From these preliminary data we conclude and suggest that modified Duhamel procedure without covering colostomy is a safe procedure with minimal complications and good results.

PakMediNet -Pakistan's largest Database of Pakistani Medical Journals - http://www.pakmedinet.com