Laparoscopy-Assisted Duhamel-Z Anastomosis for Total Colonic Aganglionosis: Outcome Assessed by Fecal Continence Evaluation.

Abstract

A Z-shaped colorectal side-to-side anastomosis was introduced to improve the Duhamel procedure by eliminating the rectal blind pouch. We retrospectively reviewed all total colonic aganglionosis patients treated by laparoscopy-assisted Duhamel-Z (LapDZ) between 2009 and 2014 focusing on annual fecal continence evaluation scores (CES) as an indicator of outcome. LapDZ was performed conventionally. Postoperatively, defecation was regulated with medications and enemas according to our standard protocol. Stool frequency, stool consistency, fecal soiling/incontinence, growth, and severity of enterocolitis were each scored (0-2) to give a total CES (maximum: 10). Eleven subjects (6 males and 5 females) were reviewed. Mean age and mean weight at LapDZ were 10.2 months and 8.4 kg, respectively. Mean length of the aganglionic ileum resected was 19.5 cm. Mean operative time was 6.2 hours. Postoperative recommencement of oral intake took 5.7 days on average. There were no intraoperative complications, no anastomotic leaks or strictures, and no intestinal obstruction. Postoperative blood transfusion was required in 1 case complicated by chronic bleeding. No subject has been constipated postoperatively. Follow-up was for 5 years. The number of subjects who had CES assessments each year was: after 1 year (n = 11), after 2 years (n = 10), after 3 years (n = 10), after 4 years (n = 8), and after 5 years (n = 5). Average annual CES during follow-up were 4.5, 6.1, 7.7, 8.1, and 8.4, respectively. LapDZ and strict management of postoperative bowel function may have contributed to improving CES over time.