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Murine Ileocolic Bowel Resection with Primary Anastomosis
Published on: October 29, 2014
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.
Insights
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.
- 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.
Background/Purpose:
Reoperation for Hirschsprung's disease traditionally has been used for patients with anastomotic leaks or stricture or with severe constipation from retained aganglionic segment or neuronal dysplasia, but there is little information regarding its use for other complications and the long-term outcome in these patients.
Methods:
In a 23-year period, 107 infants and children underwent Soave (68 patients) or Duhamel (39 patients) pull-through procedures. The age at operation was newborn to 6 years (mean, 10 months). Eighty percent had aganglionosis limited to the rectosigmoid colon. Follow-up was by office visit or telephone (mean, 8.5 years).
Results:
Twenty-three of the 68 patients with Soave pull-through (34%) underwent reoperation for intractable enterocolitis (10 patients, all 10 cured); anastomotic stenosis (four patients, three cured, one continued diversion); anastomotic leak (four patients, four cured); retained aganglionic segment (three patients, three cured); one necrosis of pull-through converted to Duhamel and cured; and one rectal prolapse that was diverted. Fifteen of the 39 patients with Duhamel procedure (38%) underwent reoperation for severe constipation (seven patients, six cured, one diverted); persistent rectal septum (four patients, 4 cured); and intractable enterocolitis (four patients, three cured, one diverted). Overall, 21 of 23 patients (91%) with reoperation after Soave procedures were cured, whereas 13 of 15 patients (87%) who underwent reoperation after Duhamel procedure were cured, and four patients remain diverted.
Conclusions:
These data show that aggressive reoperation can result in a high cure rate in Hirschsprung's disease. Although there is no significant difference in the rate of reoperation after Duhamel and Soave procedures, the patients with Soave pull-through required more complex reoperations, with several requiring more than one procedure. An aggressive approach to reoperation in patients with Hirschsprung's disease clearly is justified.
