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Does transitional zone pull-through in Hirschsprung's disease imply a poor prognosis?
Marie-Klaire Farrugia1, Nicholas Alexander, Simon Clarke
1Department of Paediatric Surgery, St George's Hospital, London, UK England.
Journal of Pediatric Surgery
|December 11, 2003
Summary
Transitional zone pull-through (TZPT) occurs in 18.8% of Duhamel procedures. While continence is unaffected, TZPT patients face higher risks of enterocolitis and constipation, often requiring revisional surgery.
Area of Science:
- Pediatric Surgery
- Colorectal Surgery
- Surgical Pathology
Background:
- Accurate intraoperative frozen section interpretation is vital for the Duhamel procedure.
- Errors can lead to abnormal pull-through, impacting patient outcomes.
- Transitional zone pull-through (TZPT) is a potential complication.
Purpose of the Study:
- To determine the incidence of transitional zone pull-through (TZPT) after the Duhamel procedure.
- To evaluate the outcomes of children with TZPT.
- To compare TZPT outcomes with ganglionic pull-through.
Main Methods:
- Prospective follow-up of 96 children who underwent the Duhamel procedure (1987-2002).
- Comparison of 18 children with TZPT to 58 children with ganglionic pull-through.
- Statistical analysis of outcomes including enterocolitis, constipation, continence, and need for revision.
Main Results:
- The incidence of TZPT was 18.8%.
- TZPT was associated with significantly higher rates of enterocolitis (P=.003) and intractable constipation (P=.02).
- 27.8% of TZPT patients required revisional surgery, compared to 3.4% in the ganglionic group (P=.007).
Conclusions:
- Transitional zone pull-through (TZPT) occurs in a significant proportion of Duhamel procedures.
- Patients with TZPT have an increased risk of enterocolitis and constipation, often necessitating revisional surgery.
- Continence is not significantly affected by TZPT, but vigilance for complications is warranted.