A new look at an old operation for aganglionosis.

Since 1980, the authors have operated on seven infants with total colon Hirschsprung's disease using the long Duhamel procedure. All infants were given an ileostomy when the diagnosis was made, and the long Duhamel procedure was performed between 6 and 24 months of age. This operation in the standard Duhamel procedure except that the sigmoid and descending colon form the fecal reservoir (as in the Martin variation of the Duhamel operation). A covering loop ileostomy was made in all the patients, and it was closed within 5 months; two infants had one episode of enterocolitis, 1 to 9 months after closure. The seven infants have had follow-up for 1 to 13 years; all are alive and well. The children are continent and toilet trained (age not withstanding); they have up to 10 formed stools per day. Two had some soiling at night. Whereas in the past the Duhamel procedure (in which a too-long anterior rectal pouch was left) often resulted in the formation of a fecal impaction, this does not occur when the material passing through the anus is at best semiliquid. With no long side-to-side anastomosis, the procedure is simple and complications are few.