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Published on: April 26, 2019
Reoperative surgery for Hirschsprung disease
Matthew W Ralls1, Arnold G Coran, Daniel H Teitelbaum
1C.S. Mott Children's Hospital, University of Michigan Hospital and Health Systems, Ann Arbor, MI, USA.
Insights
Most children with Hirschsprung disease have successful treatment, but some experience persistent stooling issues. Reoperation may be needed for complications like aganglionosis or enterocolitis.
Area of Science:
- Pediatric surgery
- Gastroenterology
- Clinical outcomes
Background:
- Hirschsprung disease (HSCR) affects the large intestine, causing stooling problems.
- While most children achieve continence after initial surgery, a subset develops persistent issues.
Purpose of the Study:
- To outline diagnostic and surgical strategies for managing persistent stooling issues after initial Hirschsprung disease treatment.
- To address complications requiring reoperation in pediatric patients.
Main Methods:
- Review of diagnostic approaches for persistent stooling issues.
- Description of surgical techniques for redo pull-through procedures.
- Analysis of complications including aganglionosis, enterocolitis, torsion, and stricture.
Main Results:
- Persistent stooling issues are manageable nonoperatively in most cases.
- Reoperation is necessary for a small group of children with specific complications.
- Surgical approach is tailored to the individual complication.
Conclusions:
- Effective management of post-Hirschsprung disease stooling issues requires a tailored diagnostic and surgical approach.
- Addressing complications like aganglionosis, enterocolitis, torsion, and stricture is crucial for successful reoperation.
Abstract:
Despite most children undergoing a successful pull through for Hirschsprung disease, a small portion of children are left with persistent stooling issues. Most of these stooling issues can be addressed by nonoperative approaches. However, in a small group of remaining children, a reoperation may be necessary. Most children who may need a redo pull-through procedure may have a persistent area of aganglionosis, unremitting enterocolitis, or a torsion or stricture of the pull-through segment. Each of these influences the approach the surgeon must take to correct the presenting problem. The chapter details the diagnostic approach as well as the operative techniques, which best deal with each of these complications.
