Surgical approach and functional outcome of redo pull-through for postoperative complications in Hirschsprung’s disease
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In brief
In brief
Retrospective study of 36 children undergoing redo pull-through for Hirschsprung complications found that transanal mucosectomy with partial sphincterectomy was effective regardless of initial complication type. Functional outcomes correlated strongly with residual colon length, with partial colectomy patients showing significantly less soiling and enterocolitis than those requiring subtotal/total colectomy.
Written by the GCMD Library team from the article.
Abstract
Aim
To review our surgical experience and outcome of redo pull-through for various postoperative complications of Hirschsprung’s disease.
Methods
A retrospective study was performed on children who underwent redo pull-through from 2016 to 2019. Operative methods and functional outcomes were compared between those with anastomotic complications (stricture and fistula, n = 12) and patients without anastomotic complications (n = 24) such as residual aganglionosis/transition zone, twisted pull-through and tight soave cuff.
Result
36 Patients (29 male and 7 female) were included with median age 6 (0.1–54) months at primary and 36 (9–144) months at redo pull-through. A transanal rectal mucosectomy and partial internal anal sphincterectomy (TRM-PIAS) pull-through with laparoscopic (n = 10, 27.8%) or laparotomy (n = 26, 72.2%) assisted techniques were performed for all patients during redo procedure. Patients with anastomotic complications had lower incidence of successful laparoscopic pull-through (0%), higher postoperative complications (25%) after redo surgery, but similar functional outcomes compared to those without anastomotic complications (41.6% underwent laparoscopic surgery, 4.2% complications). Patients with partial colectomy had significantly less soiling (36.4%) and enterocolitis (0%) compared to those with subtotal/total colectomy (79.2% soiling and 58.3% enterocolitis).
Conclusion
TRM-PIAS with/without laparoscopic-assisted redo pull-through was effective in treating various complications after primary pull-through. The functional outcome is strongly associated with the length of residual colon after redo pull-though.