" The Laparoscopic Assisted Duhamel Pull through Procedure for Hirschsprung’s Disease: Our Technique and Short Term Results "

Aims To prospectively evaluate the laparoscopic assisted Duhamel pull through LADPT procedure for Hirschsprung rsquo s disease at our centre Material and methods After clinico radiological diagnosis of Hirschsprung rsquo s disease junctional colostomy and mutltiple seromuscular biopsy was taken After histological confirmation of diagnosis definitive surgery was done by laparoscopic assisted Duhamal procedure Mobilization of aganglionic bawel and colon proximal to leveling colostomy was done laproscopically The leveling colostomy taken down bowel divided at the ganglionic segment proximal colon pulled into retro rectal avascular tunnel all through the colostomy incision Transanal stapled side to side colo rectal anastomosis was done with rectal stump closure LADPT were done from March This was retrospectively compared with the cases of open Duhamel procedures Results Mean age of surgery was plusmn months comparable in both groups ranged m yrs Mean operative time blood loss and hospital stay with range were plusmn minutes plusmn ml and plusmn days less in LADPT cases compared with open Duhamel p value and respectively Per operative one left ureteric injury occurred in LADPT In one year of follow up revision LADPT for neuronal intestinal dysplasia and re exploration due to small bowel stricture were needed in one patient each there was one death due to fulminant enterocolitis Conclusions In terms of ease of mobilization of the rectum and sigmoid colon hemostasis shorter operative time less analgesic requirement early postoperative recovery and small abdominal scar LADPT is a feasible procedure for Hirschsprung rsquo s Disease with a junctional colostomy Aims To prospectively evaluate the laparoscopic assisted Duhamel pull through LADPT procedure for Hirschsprung rsquo s disease at our centre Material and methods After clinico radiological diagnosis of Hirschsprung rsquo s disease junctional colostomy and mutltiple seromuscular biopsy was taken After histological confirmation of diagnosis definitive surgery was done by laparoscopic assisted Duhamal procedure Mobilization of aganglionic bawel and colon proximal to leveling colostomy was done laproscopically The leveling colostomy taken down bowel divided at the ganglionic segment proximal colon pulled into retro rectal avascular tunnel all through the colostomy incision Transanal stapled side to side colo rectal anastomosis was done with rectal stump closure LADPT were done from March This was retrospectively compared with the cases of open Duhamel procedures Results Mean age of surgery was plusmn months comparable in both groups ranged m yrs Mean operative time blood loss and hospital stay with range were plusmn minutes plusmn ml and plusmn days less in LADPT cases compared with open Duhamel p value and respectively Per operative one left ureteric injury occurred in LADPT In one year of follow up revision LADPT for neuronal intestinal dysplasia and re exploration due to small bowel stricture were needed in one patient each there was one death due to fulminant enterocolitis Conclusions In terms of ease of mobilization of the rectum and sigmoid colon hemostasis shorter operative time less analgesic requirement early postoperative recovery and small abdominal scar LADPT is a feasible procedure for Hirschsprung rsquo s Disease with a junctional colostomy