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Redo pullthrough for Hirschsprung disease: a single surgical group's experience.

Matthew W Ralls¹, Jennifer J Freeman¹, Raja Rabah²

¹Section of Pediatric Surgery, Department of Surgery, University of Michigan Health System, Ann Arbor, MI 48109.

Journal of Pediatric Surgery

|August 24, 2014

Summary

Redo pullthrough surgery for Hirschsprung disease (HD) can yield good results, with similar continence rates to primary pullthrough. However, stooling patterns and enterocolitis scores were worse after redo pullthrough (RedoPT) for HD.

Keywords:

Aganglionosis Endorectal pullthrough Enterocolitis Hirschsprung disease Pullthrough Reoperation Stricture

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Area of Science:

Pediatric Surgery
Gastroenterology
Clinical Outcomes Research

Background:

Hirschsprung disease (HD) is a congenital condition requiring surgical intervention.
Redo pullthrough (RedoPT) is a secondary surgical procedure for HD patients with suboptimal outcomes after initial surgery.
This study evaluates the surgical experience and outcomes of RedoPT for HD.

Purpose of the Study:

To review the surgical experience and clinical outcomes of redo-pullthrough (RedoPT) procedures for Hirschsprung disease (HD).
To assess and compare stooling patterns and continence rates in patients undergoing RedoPT versus primary pullthrough (PT) for HD.

Main Methods:

Retrospective review of RedoPT cases from one institution and an author's overseas cases.
Stooling scores were collected using a validated survey tool.
Comparison of stooling scores between RedoPT patients and a matched group of primary PT patients.

Main Results:

46 patients underwent RedoPT between 1974 and 2012, representing 3% of all HD pullthroughs.
Indications for RedoPT included aganglionosis/transition zone pathology (71%), stricture (19%), and tight cuff (8%).
RedoPT patients had significantly worse stooling pattern and enterocolitis scores (P<0.05) but similar overall continence rates compared to primary PT patients.

Conclusions:

RedoPT is a viable option for selected pediatric patients with Hirschsprung disease.
While continence rates are comparable to primary PT, RedoPT patients experience poorer stooling patterns and higher rates of enterocolitis.