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Posterior myotomy/myectomy for persistent stooling problems in Hirschsprung's disease
Barbara E Wildhaber1, Mikko Pakarinen, Risto J Rintala
1Section of Pediatric Surgery, C.S Mott Children's Hospital, University of Michigan Health System, Ann Arbor, MI, USA.
Journal of Pediatric Surgery
|June 9, 2004
Summary
Posterior myotomy/myectomy (POMM) offers moderate success for Hirschsprung
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Genetics
Background:
- Hirschsprung's disease (HD) patients often experience persistent constipation or enterocolitis (EC) after initial pull-through (PT) surgery.
- Posterior myotomy/myectomy (POMM) is a potential surgical option for managing these post-operative complications.
- This study evaluates the efficacy of POMM in HD patients who have previously undergone PT.
Purpose of the Study:
- To assess the outcomes of posterior myotomy/myectomy (POMM) in patients with Hirschsprung's disease (HD) following pull-through (PT) surgery.
- To determine the effectiveness of POMM in treating recalcitrant constipation and recurrent enterocolitis (EC) in this patient population.
- To identify factors influencing the success of POMM, including the presence of residual aganglionosis.
Main Methods:
- Retrospective review of 348 Hirschsprung's disease (HD) patient records.
- Analysis of outcomes for 32 patients who underwent posterior myotomy/myectomy (POMM) after initial pull-through (PT).
- Statistical analysis using linear and logistic regression to assess functional outcomes.
Main Results:
- Posterior myotomy/myectomy (POMM) showed a 60% success rate for chronic constipation and a 75% success rate for recurrent enterocolitis (EC).
- Patients with residual aganglionosis and constipation had poor outcomes (83% failure rate) with POMM.
- No correlation was found between the type of POMM (myotomy vs. myectomy) and overall functional outcome.
Conclusions:
- Posterior myotomy/myectomy (POMM) is a moderately successful intervention for chronic constipation or recurrent enterocolitis (EC) in Hirschsprung's disease (HD) patients post-pull-through (PT).
- Redo pull-through surgery is recommended for patients with both constipation and residual aganglionosis, given the poor response to POMM in this subgroup.
- POMM can be effective for EC, with patients not responding to POMM not requiring further redo-PT.