Redo surgery in Hirschsprung disease: what did we learn? Unicentric experience on 70 patients

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• 作者：Alessio Pini-Prato ; Girolamo Mattioli ; Camilla Giunta ; Stefano Avanzini ; Paolo Magillo ; Giovanni Maria Bisio ; Vincenzo Jasonni
• 关键词：Hirschsprung ; Redo ; Pull-through ; Outcome ; Complications
• 刊名：Journal of Pediatric Surgery
• 出版年：2010
• 出版时间：April 2010
• 年：2010
• 卷：45
• 期：4
• 页码：747-754
• 全文大小：264 K

文摘

ss=""h4"">Purpose

This article is aimed at describing a series of 70 patients who underwent a redo pull-through in the period between January 1991 and January 2007 and to compare them with a series of consecutive patients with Hirschsprung disease who underwent a single pull-through.

ss=""h4"">Methods

The notes were reviewed, and a comprehensive interview based on a disease-specific questionnaire for continence and quality of life was submitted to all eligible patients. We used a number of consecutive patients who underwent a single pull-through for Hirschsprung disease as control group.

ss=""h4"">Results

Seventy patients were included. Residual aganglionosis in pulled-through bowel or retained aganglionic rectum represented the indications to reoperation in most cases. Intestinal obstruction represented the leading symptom in more than 60 % of patients. We adopted either the endorectal pull-through, the Duhamel, or the Swenson procedure. Thirty-six patients were assessed for long-term outcome. One third experienced complications. Long-term continence was satisfactory in 70 % .

Enterocolitis, soiling, and perineal excoriations were complained by 30 % . Excellent to good perspectives were described by 94 % , and excellent to good cosmetic results by 22 % . The only significant difference with control group (109 patients) involved cosmetic appearance, whereas soiling, although more frequent, could not be considered significantly increased.

ss=""h4"">Conclusions

Patients who experience failure of a pull-through must go through multiple procedures to achieve definitive results. Although overall outcome does not significantly differ from that of a single effective pull-through, great efforts should be made to minimize complications and avoid the need for a redo, which requires experienced surgeons and highly committed families for a longer course of the disease.