Minimally Invasive Redo Pull-Throughs in Hirschsprung Disease

Area of Science:

• Pediatric Surgery
• Gastrointestinal Surgery
• Minimally Invasive Surgery

Background:

• Reoperation for Hirschsprung disease (HSCR) is challenging, often necessitating conventional laparotomy.
• Postoperative obstructive symptoms are a known complication in HSCR patients.
• Minimally invasive surgery (MIS) offers potential advantages for complex surgical cases.

Purpose of the Study:

• To evaluate the safety and efficacy of minimally invasive redo pull-throughs (MIRPT) in HSCR patients with postoperative obstructive symptoms.
• To compare outcomes of MIRPT (laparoscopic or robotic) with conventional laparotomic redo procedures.

Main Methods:

• Retrospective analysis of consecutive HSCR patients undergoing MIRPT between January 2012 and January 2020.
• Data collected included indications, surgical details, complications, and outcomes.
• Comparison group comprised patients who underwent conventional laparotomic redo pull-throughs.

Main Results:

• Sixteen patients underwent MIRPT (11 laparoscopic, 5 robotic) with a median follow-up of 49 months.
• Indications for reoperation included transition zone pull-through, residual aganglionosis, and anastomotic issues.
• MIRPT showed significantly lower overall complication rates (6%) compared to laparotomy (43%) (P=.0067).
• Continence was excellent to good in 75% of assessed patients postoperatively.

Conclusions:

• Minimally invasive redo pull-throughs are effective and safe for managing complicated HSCR cases with obstructive symptoms.
• Robotic surgery may offer specific advantages in these complex reoperations.
• MIS, combined with fast-track care, provides a viable and beneficial approach for challenging HSCR reoperations.