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Diagnosis of Hirschsprung's Disease by Immunostaining Rectal Suction Biopsies for Calretinin, S100 Protein and Protein Gene Product 9.5
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Why Do the Patients with Hirschsprung Disease Get Redo Pull-Through Operation?
Ji-Won Han1, Joong Kee Youn2, Chaeyoun Oh3
1Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
Summary
Redo pull-through (PT) surgery is needed in 7.5% of Hirschsprung disease patients due to pathologic or anatomic issues. Longer operations, complications, and the transanal endorectal PT approach are linked to redo PT needs.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Medical Genetics
Background:
- Hirschsprung disease (HD) management primarily involves pull-through (PT) surgery.
- Redo PT is required in 1-10% of cases following initial surgery.
- Understanding redo PT causes and factors is crucial for improving patient outcomes.
Purpose of the Study:
- To investigate the causes and associated factors of redo pull-through (PT) surgery in Hirschsprung disease (HD) patients.
- To analyze the relationship between initial PT approach and the need for subsequent redo PT.
- To identify risk factors contributing to redo PT in HD.
Main Methods:
- Retrospective review of medical charts for 657 HD patients who underwent surgery from 1979 to 2016.
- Analysis of indications for redo PT, including persistent obstructive symptoms, transition zone visualization, and anatomical issues.
- Comparison of factors between patients requiring redo PT and those who did not.
Main Results:
- Redo PT was performed in 7.5% (49/657) of patients.
- Primary causes for redo PT were pathologic problems (28 cases) and anatomic problems (21 cases).
- Factors associated with redo PT included longer initial PT operation time, increased postoperative complications, and the transanal endorectal PT (TERPT) approach.
Conclusions:
- Approximately 7.5% of HD patients require redo PT surgery.
- Pathologic and anatomic issues are the main drivers for redo PT.
- Longer operative times, complications, and the TERPT approach are significant factors associated with redo PT.
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