Comparison of Transanal One-stage Soave Procedure to Modified Duhamel Procedure in Hirschsprung's Disease

Purpose: Transanal one-stage Soave (TOS) procedure is the most recently reported procedure for Hirschsprung’s disease. This study was performed to compare the surgical outcomes of TOS with those of modified Duhamel procedure. Methods: The study populations were 17 consecutive patients who underwent TOS procedure between March, 2003 and February, 2008 (TOS group) and 19 consecutive patients who underwent modified Duhamel procedure between March, 1996 and February, 2001 (Duhamel group) by one pediatric surgeon. Age, gender, length of aganglionic segment, operating time, complications, duration of postoperative hospital stay, and functional results were retrospectively analyzed and compared between the two groups. Results: There was no difference in age, gender, and length of the aganglionic segment between the two groups. The operating time (195 versus 255 minutes, P＜0.05) and the duration of postoperative hospital stay (7 versus 9 days, P＜0.05) were significantly shorter in the TOS group. Postoperative complications occurred in 10 of 17 in the TOS group (4 perianal excoriation, 3 anastomotic stenosis, and 3 postoperative enterocolitis) and 10 of 19 in Duhamel group (2 wound infection, 1 perianal excoriation, 1 anastomotic leakage, 1 rectal bleeding, 2 intestinal obstruction, and 3 postoperative enterocolitis). Two cases in the Duhamel group required operation to treat postoperative complication, one for anastomotic leakage and one for intestinal obstruction. There was no significant difference in the functional results between both groups. Conclusion: TOS shows similar functional results and postoperative complications but has the advantage of a significantly shorter operating time and postoperative hospital stay compared with modified Duhamel procedure.