Tricks - New Duhamel - Laparoscopic Trans-rectal Rectosigmoidectomy
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Educational content from recorded physician discussions — not medical advice. Talk to your (or your child's) care team about your situation.
Podcast
The Colorectal Quiz Episode 4
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Video
The use of postoperative calibrations in Hirschsprung disease
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Video
Does Delayed Diagnosis of Hirschsprung Disease Impact Post-operative and Functional Outcomes? A Multi-Center Review From the Pediatric Colorectal and Pelvic Learning Consortium
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Hirschsprung Disease: Pathology Aspect
CCHMC Pediatric Surgery · 42 min · Published Feb 2015
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Hirschsprung Disease: Update Course 2015
CCHMC Pediatric Surgery · 7 min · Published Nov 2015
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CinciHirsch - Pathology of Hirschprung Disease
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Pediatric Surgical Oncology Research Collaborative (PSORC): Studying Rare Pediatric Tumors
56 s · Published May 2026
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Update Course Rewind 2025: Hirschsprung + ARM: Rare but Real
1 min · Published May 2026
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Update Course Rewind 2025: Hirschsprung + ARM: Rare but Real
1 min · Published May 2026
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Pooling Patients to Study Rare Pediatric Tumors: An Introduction to PSORC
56 s · Published May 2026
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The fetal frontier: A review of current and emerging fetal therapies for genetic diseases
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Indocyanine green assists with sentinel lymph node mapping in pediatric and adolescent patients
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What the experts said
Doing everything extraperitoneally is a nice feature of the technique.
All of these techniques are good adjuncts to the armamentarium for Hirschsprung's disease, and knowing more techniques allows tailoring to appropriate patients.
Stretching the sphincters aggressively is one of the mistakes people make when doing a transanal pull-through.
A transanal pull-through should be done by pulling everything out and doing it on the outside without stretching the sphincters.
In early experience with laparoscopic Duhamel, the colon was brought outside and transected outside, then put back again when there were difficulties closing the stump.
With increased experience, the colon is no longer brought outside and a pretty short stump is left.
Even if more stump is left, it can be trimmed later before closing the stump down.
Using the end of a GIA stapler for making the side-to-side anastomosis allows the technique to be used even in neonates at a very early age.
The new Duhamel pull-through was designed to eliminate the septic intraabdominal step, avoid intraabdominal sutures, determine the length of the residual stump, and assure a more secure colorectal anastomosis.
The posterior rectal wall incision is made 1.5 centimeters from the dentate line.
The retrorectal tissue is easily dissected digitally, allowing access to the retrorectal space to the sacral promontory.
Dissection is performed along the lateral walls of the rectum approximately 50% of the circumference of the posterior rectal wall.
The laparoscopic endopelvic dissection and entry into the retrorectal space is described as basically a bloodless process.
The sigmoid is stapled transversely with a GIA stapler 75 millimeters, which can be reinforced with PDS or Vicryl invaginating sutures.
The level at which to cut is defined by pathologic markers intraoperatively by frozen section or by mapping a transition zone with previous suction biopsies.
The anastomosis is completed with the Martin technique and modification, leaving a very ample window with minimal chance of stenosis.
At 6 months postoperatively, colonoscopy showed a residual pouch of approximately 3 centimeters in an asymptomatic patient.
Problems that can occur include accumulation of feces, constipation, and fecal impaction when the stump is left too long.
The residual stump can be divided if necessary, as demonstrated via video.
The technique is recommended for all pediatric patients, including patients with very dilated colons, and is described as reproducible, easy, and fast with minimal incidence of constipation and stenosis.