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Journal of Indian Association of Pediatric Surgeons
     Journal of Indian Association of Pediatric Surgeons
Official journal of the Indian Association of Pediatric Surgeons         
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Year : 2001  |  Volume : 6  |  Issue : 3  |  Page : 72-76

Failure of modified dhumel's operation. The lower anal incision : the crux of the problem


Ankur Hospital for Children, 1666/ E 10th lane Rajarampuri, Kolhapur 416001 (Mah), India

Correspondence Address:
D Kittur
Ankur Hospital for Children, 1666/ E 10th lane Rajarampuri, Kolhapur 416001 (Mah)
India
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ABSTRACT: About 20 percent of patients who have had Modified Duhamel's Operation for Hirschsprung's Disease (HD), have recurrence of symptoms like incomplete evacuation, fecaloma formation and/or repeated gaseous distension. The cause of these symptoms could be anything from retained aganglionic segment, inadequately divided internal sphincter, to rectal inertia. The authors have analyzed 2 groups of patients (Total No 66) who have been investigated and treated on similar lines but differed only at the site of the lower anal incision. In Group A (26 patients) the lower anal incision was 1 cm above the mucocutaneus junction, whereas in Group B (40 patients), the incision was made at the muco-cutaneus junction. The patients in Group B had no recurrence of symptoms. The authors conclude that if one analyses the failure of Duhamel's operation for HD where diagnosis and treatment are comparable, the crux of the problem lies with the site of the lower anal incision. The anal incision at the muco-cutaneus junction during the modified Duhamel's operation gives better long term results.






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