Long-term follow-up of redo pull-through procedures for Hirschsprung's disease: Efficacy of the endorectal pull-through☆
Section snippets
Materials and methods
Patients who had undergone a redo pull-through at the C.S. Mott Children's Hospital from 1974 to 1998 were reviewed retrospectively. Patients' charts were analyzed for presentation, family history of Hirschsprung's disease, length of aganglionosis, details of all surgical procedures, episodes of enterocolitis, early and late complications, and stooling habits including continence, frequency, and need for laxatives or other medications. Follow-up information was obtained from outpatient visit
Patient population
Thirteen of our 19 patients were boys and 6 were girls. One patient had a family history positive for Hirsch-sprung's disease, and one patient had Trisomy 21. Age at initial presentation of Hirschsprung's disease varied greatly with 16 patients presenting in the newborn period (range, 1 day to 2 months) and with 3 patients experiencing a long delay until diagnosis (range, 15 months to 15 years). The primary pull-through procedures included 10 endorectal pull-throughs (ERPT), 5 Duhamel
Discussion
Despite several reports of excellent results with surgical procedures for Hirschsprung's disease, a small subgroup will inevitably have complications after a pull-through procedure.9, 10, 11, 12, 13, 14 In a select group of patients, these complications can be insurmountable without the performance of a redo pull-through. We are adding this series to a number of reports in the literature of redo pull-through cases (Table 3).Study Year No. of Cases Initial Procedure Redo
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Address reprint requests to Arnold G. Coran, MD, Section of Pediatric Surgery, University of Michigan Hospitals, Mott F3970, Box 0245, Ann Arbor, MI 48109.