Aim of study
Following a review by GIRFT where a figure of stoma formation pre-pullthrough in Hirschsprung’s Disease (HD) was given for a 2 year period, we felt we should review our indications and numbers. The aim of the study was to see if the results presented by GIRFT were accurate and how our figures compared to those reported in the BAPS-CASS review (1).
This is a retrospective review of all patients operated on for HD by the Duhamel procedure in a single centre. The review covered the period January 2008 until December 2017. Patients undergoing redo pullthroughs or having a Duhamel procedure for another aetiology were excluded.
Over the 10 year period 95 patients were included. Of those 10/95 (11%) had stomas only leaving 85/95 who had a pullthrough. Of those, 55/85 (65%) had a primary Duhamel pullthrough with 30/85 (35%) having a stoma pre-operatively. A stoma was unpreventable (e.g. presented with perforation) in 19/30 patients (22% of original eighty five patients, 63% of pre-operative stomas) whilst 11/30 patients failed rectal washouts (13% of original group, 37% of pre-operative stoma patients). Of the eleven that failed washouts, 7/11 (64%) had long segment HD.
5 patients (6%) may have been able to avoid a stoma.
The GIRFT review suggested 40% of our patients underwent pre-operative stomas. The BAPS-CASS paper stated that, nationally, 36% of patients underwent stomas pre-operatively. We have shown, over a 10 year period, 35% of our patients underwent stomas. However, in BAPS-CASS 13% had an initial stoma and 23% failed rectal washouts, whereas our figures are 22% and 13% respectively and, in our review, only 6% of patients may have received a stoma that could have been avoided.
1. Bradnock TJ et al. JPS 52 (2017) 1451-1457