Department of Surgery, Pediatric Surgery Unit, Faculty of Medicine, Cairo University Specialized Pediatric Hospital, Cairo University, Cairo, Egypt.
Afr J Paediatr Surg. 2022 Jan-Mar;19(1):27-31. doi: 10.4103/ajps.AJPS_1_21.
Hirschsprung's disease (HD) is a congenital anomaly affecting the enteric nervous system commonly the rectosigmoid region. Treatment is surgical where the aganglionic segment is resected, and bowel continuity is achieved by a colo-anal anastomosis. In 1999, Georgeson et al. proposed a new technique of primary laparoscopic-assisted pull through for HD as a new gold standard.
To evaluate the outcome of the laparoscopic Duhamel procedure for the management of HD in children older than 3 years.
This study was performed on 8 patients who were more than 3-year-old, with confirmed diagnoses of HD. Patients who initially presented with enterocolitis or obstruction were excluded from this study. In all cases, laparoscopic-assisted Duhamel was done.
We reported our results for the 1 year follow-up period and divided our results into early outcome for the first 3 months postoperative during which we had 2 cases complaining of enterocolitis that responded to conservative treatment, we observed 2 cases of perianal excoriation that responded to medical treatment while the late outcome was reported after 3 months postoperative: We had two cases with attacks of enterocolitis at 6 months and 9 months postoperatively that needed conservative treatment in the hospital in the form of parenteral antibiotics, rectal irrigation, intravenous fluids and NP0. There was neither anastomotic leak nor stenosis.
Laparoscopic Duhamel for the management of HD in children older than 3 years is safe and useful procedure.
先天性巨结肠（HD）是一种影响肠神经系统的先天性异常，通常影响直肠乙状结肠区域。治疗方法是手术切除无神经节的肠段，并通过结肠肛管吻合术实现肠道连续性。1999 年，Georgeson 等人提出了一种新的腹腔镜辅助经肛拖出术治疗 HD 的技术，作为新的金标准。
评估腹腔镜 Duhamel 手术治疗 3 岁以上儿童 HD 的效果。
本研究纳入 8 例确诊为 HD 的 3 岁以上患儿。本研究排除了最初出现肠炎或梗阻的患者。所有病例均采用腹腔镜辅助 Duhamel 手术。
我们报告了 1 年的随访结果，并将结果分为术后 3 个月内的早期结果和 3 个月后的晚期结果。早期结果中，有 2 例患儿出现肠炎，经保守治疗后缓解；2 例患儿出现肛周皮肤糜烂，经药物治疗后缓解。晚期结果中，有 2 例患儿在术后 6 个月和 9 个月时出现肠炎发作，需要在医院接受静脉抗生素、直肠冲洗、静脉补液和 NP0 等保守治疗。没有吻合口漏或狭窄的发生。
对于 3 岁以上儿童的 HD，腹腔镜 Duhamel 手术是一种安全有效的治疗方法。
