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Surgical approach and functional outcome of redo pull-through for postoperative complications in Hirschsprung's
Qi Li1, Zhen Zhang1, Ping Xiao2
1Department of General Surgery, Capital Institute of Pediatrics, Beijing, China.
Insights
Redo pull-through surgery effectively treats Hirschsprung
Area of Science:
- Pediatric Surgery
- Gastrointestinal Surgery
Background:
- Hirschsprung's disease requires surgical correction, often involving pull-through procedures.
- Postoperative complications can necessitate redo pull-through surgery.
Purpose of the Study:
- To evaluate the surgical experience and outcomes of redo pull-through for managing complications after primary pull-through surgery for Hirschsprung's disease.
Main Methods:
- A retrospective study analyzed 36 children undergoing redo pull-through between 2016-2019.
- Compared outcomes between patients with anastomotic complications (n=12) and those without (n=24).
- Utilized transanal rectal mucosectomy and partial internal anal sphincterectomy (TRM-PIAS) with laparoscopic or laparotomy assistance.
Main Results:
- Patients with anastomotic complications had lower laparoscopic pull-through success (0%) and higher redo surgery complications (25%) but similar functional outcomes.
- Partial colectomy was associated with significantly less soiling (36.4%) and enterocolitis (0%) compared to subtotal/total colectomy (79.2% soiling, 58.3% enterocolitis).
Conclusions:
- Transanal rectal mucosectomy and partial internal anal sphincterectomy (TRM-PIAS) with laparoscopic assistance is effective for redo pull-through in Hirschsprung's disease.
- Functional outcomes are strongly linked to the length of the residual colon post-redo pull-through.
Aim:
To review our surgical experience and outcome of redo pull-through for various postoperative complications of Hirschsprung's disease.
Methods:
A retrospective study was performed on children who underwent redo pull-through from 2016 to 2019. Operative methods and functional outcomes were compared between those with anastomotic complications (stricture and fistula, n = 12) and patients without anastomotic complications (n = 24) such as residual aganglionosis/transition zone, twisted pull-through and tight soave cuff.
Result:
36 Patients (29 male and 7 female) were included with median age 6 (0.1-54) months at primary and 36 (9-144) months at redo pull-through. A transanal rectal mucosectomy and partial internal anal sphincterectomy (TRM-PIAS) pull-through with laparoscopic (n = 10, 27.8%) or laparotomy (n = 26, 72.2%) assisted techniques were performed for all patients during redo procedure. Patients with anastomotic complications had lower incidence of successful laparoscopic pull-through (0%), higher postoperative complications (25%) after redo surgery, but similar functional outcomes compared to those without anastomotic complications (41.6% underwent laparoscopic surgery, 4.2% complications). Patients with partial colectomy had significantly less soiling (36.4%) and enterocolitis (0%) compared to those with subtotal/total colectomy (79.2% soiling and 58.3% enterocolitis).
Conclusion:
TRM-PIAS with/without laparoscopic-assisted redo pull-through was effective in treating various complications after primary pull-through. The functional outcome is strongly associated with the length of residual colon after redo pull-though.
