The Use of Mechanical Suture in the Treatment of Hirschsprung s Disease: Experience of 17 Cases
R.I. SpataruOriginal article, no. 2, 2014
Introduction: Hirschsprung’s disease, or congenital megacolon,is a malformation characterised by the absence of ganglioncells in the distal bowel. Most often, the aganglionic segmentincludes the rectosigmoid, but it may extend proximally tovariable length. In late years, significant improvementsregarding the surgical treatment of Hirschsprung’s disease weremade, by the introduction of both one-stage transanalendorectal pull-through â€" laparoscopically assisted or not - andmechanical suture devices.Aim: The purpose of this paper is to analyse our results withmodified Duhamel procedure by using mechanical suturesfor construction of a sideâ€"toâ€"side colo-rectal anastomosisMaterials and Method: We analysed 17 congenital megacoloncases operated in our department between 2007 â€" 2011 by thesame pediatric surgical team, using the modified Duhameltechnique performed with mechanical suture. It is the firstseries operated in our country using this procedure. 2 patientshad a long colonic aganglionosis, 2 patients had a shortaganglionotic segment and 13 patients had the common formof the disease. Mainly, we focused on technical details,hospitalization period, and immediate and late complications.Results: The mean hospitalization period was of 9 days.Mortality in our series was 0. Postoperative complicationsconsisted in minor bleeding (5 cases), adhesions andmechanical occlusion (1 case), and subocclusive symptoms dueto remnant septum with subsequent fecaloma formation in therectal ampula (4 cases). All of our operated cases hadconsequently a very good fecal continence.Conclusions:We think that usage of mechanical suture devicesin a single stage Duhamel procedure is extremely beneficialregarding both complication rate and hospitalisation time.This technique is safe, simple and efficient.
