Analysis of problems, complications, avoidance and management with transanal pull-through for Hirschsprung disease

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• 作者：Akshay Pratap ; Devendra Kumar Gupta ; Vikal Ch ; ra Shakya ; Shailesh Adhikary ; Awadhesh Tiwari ; Pramod Shrestha ; Sagar Raj P ; ey ; Rajesh Kumar Yadav
• 刊名：Journal of Pediatric Surgery
• 出版年：2007
• 出版时间：November 2007
• 年：2007
• 卷：42
• 期：11
• 页码：1869-1876
• 全文大小：823 K

文摘

Background

The primary aim of this study is to detail the problems, complications, their avoidance, and management with transanal pull-through developed from experience with 65 patients.

Methods

A retrospective study of 65 patients who underwent transanal pull-through between January 2002 and December 2006 was conducted. Their medical charts and operative notes were reviewed for problems encountered during surgery, postoperative period, and follow-up.

Results

In 46 patients, a primary transanal pull-through was performed, whereas in 19 with a prior colostomy, followed staged pull-through was done. The minimum follow-up was 6 months, with an average of 22 months after surgery (range, 6-47 months). Sixteen patients (25 % ) experienced at least 1 complication. These included inadvertent full-thickness mobilization of the rectum in 3 (4.6 % ), retraction and bleeding of colonic mesenteric vessels in 2 (3.7 % ), difficulty in mobilizing intraperitoneal colon in 1 (1.5 % ), and a false-positive frozen section in 2 patients (3 % ). Early postoperative complications occurred in 7 patients (11 % ), which included sphincter spasm in 3 (4.6 % ), anastomotic leak in 1 (1.5 % ), cuff abscess in 2 (3 % ), and enterocolitis in 1 (1.5 % ). Late postoperative complications in 46 patients (70 % ), occurring from 1 week till 3 months of follow-up included perianal excoriation in 22 (34 % ), increased stool frequency in 20 (31 % ), anal stenosis in 3 (4.6 % ), and enterocolitis in 2 patients (3 % ). Methodology is detailed for avoidance and management of problems and complications. Individual patient analysis, complications timing, and strategy for management are discussed.

Conclusion

Patient outcomes for transanal pull-through have improved significantly as a result of combination of experience and the ability to avoid and manage associated complications. Experience, avoidance, and interdiction are key factors in complication management.