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Related Experiment Videos

Reoperation for Hirschsprung's disease.

T R Weber1, R S Fortuna, M L Silen

  • 1Department of Surgery, St. Louis University School of Medicine and Cardinal Glennon Children's Hospital, MO 63104, USA.

Journal of Pediatric Surgery
|February 18, 1999
PubMed
Summary
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Aggressive reoperation for Hirschsprung's disease complications leads to high cure rates. This study supports an assertive surgical approach for improved long-term outcomes in pediatric patients.

Area of Science:

  • Pediatric Surgery
  • Gastrointestinal Surgery
  • Congenital Disorders

Background:

  • Hirschsprung's disease (HSCR) is a congenital condition characterized by the absence of ganglion cells in the distal bowel.
  • Reoperation for HSCR is typically reserved for anastomotic leaks, strictures, or severe constipation due to residual aganglionic segments.
  • Limited data exists on reoperation for other HSCR complications and their long-term results.

Purpose of the Study:

  • To evaluate the efficacy and long-term outcomes of reoperations for various complications of Hirschsprung's disease.
  • To compare reoperation rates and outcomes between the Soave and Duhamel pull-through procedures.
  • To determine if an aggressive reoperative strategy is justified for HSCR.

Main Methods:

  • A retrospective review of 107 infants and children who underwent Soave (68) or Duhamel (39) pull-through procedures for HSCR over 23 years.

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  • Patients' age ranged from newborn to 6 years (mean 10 months).
  • Follow-up averaged 8.5 years via office visits or telephone.

    • Main Results:

    • 34% (23/68) of Soave patients and 38% (15/39) of Duhamel patients required reoperation for complications like enterocolitis, stenosis, leaks, or retained aganglionic segments.
    • Reoperation success rates were high: 91% (21/23) after Soave and 87% (13/15) after Duhamel procedures.
    • Four patients in total remained diverted; Soave pull-throughs necessitated more complex reoperations, sometimes multiple procedures.

    Conclusions:

    • Aggressive reoperation for Hirschsprung's disease complications yields high cure rates.
    • While reoperation rates are similar between Soave and Duhamel procedures, Soave cases may require more complex interventions.
    • An assertive approach to reoperation is strongly recommended for managing Hirschsprung's disease complications.