Laparoscopic Redo Pull-Through for Hirschsprung Disease Due to Innervation Disorders

Area of Science:

• Pediatric Surgery
• Gastroenterology
• Pathology

Background:

• Reoperations for Hirschsprung disease (HD) are often necessitated by underlying pathological issues.
• This study investigates the incidence and outcomes of innervation disorders in HD patients requiring repeat pull-through surgery.

Purpose of the Study:

• To determine the incidence of innervation disorders in HD patients undergoing reoperation.
• To evaluate the outcomes of redo pull-through operations in this patient cohort.

Main Methods:

• A retrospective review of patients treated for HD between 2005 and 2017 was conducted.
• Analysis focused on patients who underwent reoperation due to histological findings, excluding those with mechanical obstruction.

Main Results:

• Of 836 HD patients, 72 (8.6%) required reoperation. Abnormal histological findings were present in 31 (43.1%) of these patients.
• Diagnoses included aganglionosis, transition-zone disorders, intestinal neuronal dysplasia B (IND B), and hypoganglionosis.
• Following redo laparoscopic-assisted Duhamel or Soave procedures, 77.4% of patients achieved excellent/good bowel function.

Conclusions:

• Innervation disorders are a significant cause of recurrent constipation, necessitating reoperation in nearly half of HD patients.
• Redo pull-through surgery, specifically laparoscopic-assisted Duhamel or Soave techniques, yields satisfactory outcomes for the majority of patients.