Functional Evaluation of children following Modified Duhamel Procedure for Rectosigmoid Hirschsprung’s Disease

Background Hirschsprung’s disease is a congenital disorder of intestinal innervation requiring surgical correction. The modified Duhamel retro-rectal pull-through is widely used for rectosigmoid hirschsprung’s disease, but long-term functional outcomes remain variable. This study aimed to evaluate bowel function, complications, and quality of life in children undergoing this procedure. Methods A prospective study was conducted at a tertiary care hospital (January2022 to November 2025). Fifty children with biopsy-confirmed rectosigmoid HD who underwent the modified Duhamel pull-through were included, with ≥ 3 years follow-up. Functional outcomes were assessed using the Rintala Bowel Function Score and clinical evaluation. Secondary outcomes included postoperative complications, need for medical/surgical interventions, and quality of life indicators. Results The study comprised 38 males (76%) and 12 females (24%), mean age at surgery 1.5 ± 0.5 years, and at assessment 6.2 ± 2.1 years. Early complications included anastomotic leak (2%), wound infection (8%), and Hirschsprung-associated enterocolitis (HAEC) (10%). Late morbidities included constipation requiring prolonged medical management (20%), residual spur (4%), and recurrent HAEC (14%). The mean BFS was 17.1 ± 2.9; 48% achieved good outcomes (≥ 18), 38% fair (13–17), and 14% poor (≤ 12). Symptom analysis showed no soiling in 64%, no constipation in 76%, and normal stool frequency in 76%. Quality of life was favorable, with 86% parental satisfaction, 92% regular school attendance, and 6% reporting social embarrassment. Conclusion The modified Duhamel procedure provides satisfactory long-term functional outcomes in most children with rectosigmoid hirschsprung’s disease. Constipation and recurrent HAEC remain the most significant late morbidities, underscoring the need for structured follow-up and individualized bowel management.