Duhamel pull-through for Hirschsprung disease: a comparison of open and laparoscopic techniques ☆ Shireen A. Nah, Paolo de Coppi, Edward M. Kiely, Joseph I. Curry, David P. Drake, Kate Cross, Lewis Spitz, Simon Eaton, Agostino Pierro ⁎ Department of General Surgery, Great Ormond Street Hospital and UCL Institute of Child Health, London, UK WC1N 1EH Received 4 November 2011; accepted 10 November 2011 Key words: Hirschsprung disease; Minimally invasive; Laparoscopic; Duhamel; Pull-through Abstract Purpose: Various pull-through techniques, both open and laparoscopic, have been performed for Hirschsprung disease. Our study compares open and laparoscopic Duhamel pull-through. Methods: After ethical approval, we reviewed all children (n = 181) with Hirschsprung disease admitted to our institution between 1999 and 2009. We excluded total colonic aganglionosis (n = 14), previous pull-through done elsewhere (n = 33), or follow-up performed abroad (n = 58). Open and laparoscopic pull-through were done in the same period according to surgeon preference. Data were analyzed using χ 2 or Mann-Whitney U test. Results: Seventy-six children had a Duhamel pull-through for rectosigmoid aganglionosis. Operative time, time to full feeds, and length of hospital stay were similar in each group. Open (n = 41): Fifteen children (37%) required 33 further procedures. Fourteen had procedures for persistent constipation, including redo Duhamel (n = 2), stoma formation (n = 2), spur division (n = 2), and dilatation/stretch/Botox/rectal biopsy/manual evacuation (n = 23). Three children had other procedures (adhesiolysis [n = 2] and incisional hernia repair [n = 1]). Laparoscopic (n = 35): Fourteen children (40%) required 30 further procedures. Eleven had procedures for persistent constipation, including redo Duhamel (n = 1), stoma formation (n = 4), spur division (n = 9), and dilatation/stretch/rectal biopsy (n = 8). Three children had other procedures (adhesiolysis [n = 1] and incisional hernia repair [n = 2]). There were 4 conversions. Conclusion: Open and laparoscopic Duhamel pull-through have similar outcomes. We show that the techniques have comparable operative times and hospital stay. © 2012 Elsevier Inc. All rights reserved. Various methods have been developed for the surgical treatment of Hirschsprung disease (HD). The traditional pull- through techniques described by Swenson, Soave, and Duhamel have been modified in attempts to reduce the size of the surgical wound, minimize injury to surrounding structures during intra-abdominal dissection, and improve bowel function [1-3]. Recently, laparoscopic surgery has been adopted in the management of HD. Presented at the 58th Annual Meeting of the British Association of Paediatric Surgeons, Belfast, Northern Ireland, July 20-22, 2011. ☆ This work was generously supported by the Mirral Research Fund. ⁎ Corresponding author. Department of Surgery, UCL Institute of Child Health, London UK WC1N 1EH. Tel.: +44 0 20 7905 2175/2641; fax: +44 0 20 7404 6181. E-mail address: pierro.sec@ich.ucl.ac.uk (A. Pierro). www.elsevier.com/locate/jpedsurg 0022-3468/$ – see front matter © 2012 Elsevier Inc. All rights reserved. doi:10.1016/j.jpedsurg.2011.11.025 Journal of Pediatric Surgery (2012) 47, 308–312