Qi Li1, Zhen Zhang1, Ping Xiao2, Ya Ma3, Yuchun Yan4, Qian Jiang5, Yee Low6, Long Li7. 1. Department of General Surgery, Capital Institute of Pediatrics, Beijing, China. 2. Department of Pathology, Capital Institute of Pediatrics, Beijing, China. 3. Department of Ultrasound, Capital Institute of Pediatrics, Beijing, China. 4. Department of Radiology, Capital Institute of Pediatrics, Beijing, China. 5. Department of Medical Genetics, Capital Institute of Pediatrics, Beijing, China. 6. Department of Pediatric Surgery, KK Women's and Children's Hospital, Singapore, Singapore. 7. Department of General Surgery, Capital Institute of Pediatrics, Beijing, China. lilong23@126.com.
Abstract
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.
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.
Authors: J C Langer; M D Rollins; M Levitt; A Gosain; L de la Torre; R P Kapur; R A Cowles; J Horton; D H Rothstein; A M Goldstein Journal: Pediatr Surg Int Date: 2017-02-08 Impact factor: 1.827
Authors: Matthew W Ralls; Jennifer J Freeman; Raja Rabah; Arnold G Coran; Peter F Ehrlich; Ronald B Hirschl; Daniel H Teitelbaum Journal: J Pediatr Surg Date: 2014-07-24 Impact factor: 2.545
Authors: Taiwo A Lawal; Kaveer Chatoorgoon; Margaret H Collins; Alex Coe; Alberto Peña; Marc A Levitt Journal: J Pediatr Surg Date: 2011-02 Impact factor: 2.545
Authors: Marc A Levitt; Colin A Martin; Max Olesevich; Cathy L Bauer; Lyndsey E Jackson; Alberto Peña Journal: J Pediatr Surg Date: 2009-01 Impact factor: 2.545