Outcome Comparison of Stapling Device and LigaSure for Septum Elimination in Duhamel Procedure

Introduction: The Duhamel procedure is a widely utilized surgical approach for addressing Hirschsprung Disease, a congenital condition affecting colonic innervation. The elimination of the septum between the rectum and ganglionic bowel is fundamental in this procedure and can be accomplished using either a stapling device or LigaSure. This study aims to compare the outcomes of septum elimination in the Duhamel procedure when employing these distinct devices. Methods: Retrospective analysis of patient databases and medical records was conducted for individuals undergoing Duhamel pull through surgery at our institutions between 2021 and 2023. The study focused on evaluating postoperative outcomes, specifically obstructive symptoms, Hirschsprung-associated enterocolitis (HAEC), and mortality rates. Results: The study included 96 patients, with a gender distribution of 36 males and 60 females. The majority of patients (90) presented with the short type of Hirschsprung Disease, while long-type and total colon aganglionosis accounted for 5 each. Analysis revealed a significant association between stapler usage and an increased risk of HAEC (Relative Risk RR = 9.545, 95% Confidence Interval CI = 1.1 - 78.3; p = 0.017). However, no significant correlations were observed between device usage and post-pull through obstructive symptoms (p = 0.329). Notably, there were no reported mortalities during the study period. Conclusion: LigaSure emerges as a safe and applicable alternative to stapling devices in the Duhamel procedure. This study emphasizes the importance of device selection in achieving favourable outcomes for patients with Hirschsprung Disease undergoing the Duhamel procedure.