Comparative study between transanal endorectal pull-through and modified Duhamel

Abstract

Background- Hirschsprung’s disease (HD) is a congenital disorder characterized by an absence of neuronal cell bodies in both myenteric and submucous plexuses in the intestinal wall. The aganglionosis always starts distally and is limited to the rectum and the sigmoid colon in 80–85% of the cases.HD occurs in about 1/5000 live born babies and is more common in boys than girls (4:1). Patients with HD are most often diagnosed in the neonatal period. The clinical presentation is distended abdomen, delayed passage of meconium and vomiting, older children more often present with chronic constipation, approximately 10% of patients with HD present with enterocolitis. Surgical management for HD aims at removing the aganglionic bowel and reconstructing the intestinal tract. There has been a continuous development over the years of operative techniques used for HD from multi-staged procedures (a preliminary colostomy) to one stage pull-through.Aim of the work: comparative study between transanal endorectal pull-through and modified Duhamel’s procedure in management of Hirshsprung’s disease. Patients and Methods: this randomized prospective study was done on 20 patients with Hirschsprung’s disease during the period from January 2016 to January 2018, group A included 10 patients underwent modified Duhamel’s procedure compared to group B 10 patients underwent trans-anal endorectal pull-through procedure. Results: the two techniques were nearly equivalent in the post-operative outcomes. Conclusion: currently, as there was no evidence suggesting that one technique has significant superiority over another, so it is up to surgeon’s choice to select the technique that was easy and feasible in his hands, but TEPT was preferable for neonates, with no past history of enterocolitis and using modified Duhamel’s if the two staplers were available is safe and with less complications