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Evaluation and treatment of the post pull-through Hirschsprung patient who is not doing well; Update for 2022

Hira Ahmad1, Desale Yacob2, Devin R Halleran3

  • 1Division of Pediatric General and Thoracic Surgery, Seattle Children's Hospital, Seattle, WA, United States.

Seminars in Pediatric Surgery
|June 11, 2022
PubMed

Insights

Many children struggle after Hirschsprung disease (HD) surgery. This review outlines a systematic approach to evaluate and treat post-operative complications like incontinence or enterocolitis for better outcomes.

Area of Science:

  • Pediatric Surgery
  • Gastroenterology

Background:

  • Hirschsprung disease (HD) requires surgical correction, typically a pull-through procedure.
  • A significant number of patients experience persistent complications post-operatively, despite technically adequate surgery.

Purpose of the Study:

  • To present a structured diagnostic and therapeutic strategy for managing patients with Hirschsprung disease who experience poor outcomes after pull-through surgery.
  • To address common post-operative issues including fecal incontinence, obstructive symptoms, and recurrent enterocolitis.

Main Methods:

  • Systematic review of diagnostic approaches for post-HD pull-through complications.
  • Outline of treatment modalities including medical management, reoperation, and botulinum toxin injections.

Main Results:

  • Post-operative problems in HD patients can manifest as fecal incontinence, obstructive symptoms, or enterocolitis.
  • A systematic diagnostic evaluation is crucial for identifying the cause of these complications.

Conclusions:

  • Effective management strategies, including medical interventions, surgical revision, or targeted treatments like botulinum toxin, can successfully address complications in most post-HD pull-through patients.
  • A systematic approach ensures appropriate treatment for improved patient outcomes.

Keywords:
Bowel managementConstipationEnterocolitisHirschsprung diseaseIncontinenceObstructionPost pull-through complicationsSoiling

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