Duhamel operation for Hirschsprung’s disease; laparoscopic modified Duhamel procedure with Z-shaped anastomosis
We assessed outcome of surgery for total colon aganglionosis (TCA) and classical type recto-sigmoid Hirschsprung disease (RS-HD) comparing laparoscopic Duhamel-Z (Lap-DZ) with other techniques. For Lap-DZ, four 5mm ports were used to dissect the colon from the peritoneal reflection to the ileostomy, which was then taken down, a retrorectal route for the ganglionic pull-through ileum was created, and the rectal stump resected 2 cm above the peritoneal reflection. Following pull-through, a transverse incision was made on the anterior wall of the ganglionic ileum at the level of the proximal end of the rectal stump, and the posterior wall of the rectal stump and the lower edge of the ileal anterior wall incision were anastomosed. A surgical stapler, inserted through the anus, was used to divide the posterior rectal wall and the anterior ileal wall. Finally, the anterior wall of the rectal stump and the upper edge of the ileal anterior wall incision were anastomosed to complete a Z-shaped colorectal side-to-side anastomosis without a blind pouch. Surgery and recovery were unremarkable; mean annual continence evaluation scores improved gradually over time with no constipation. Based on outcome, we recommend Lap-DZ for TCA, but not for RS-HD.