Long-term follow-up of redo pull-through procedures for Hirschsprung's disease: Efficacy of the endorectal pull-through

Presented at the 1999 Annual Meeting of the Section on Surgery of the American Academy of Pediatrics, Washington, DC, October 8-10, 1999.
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Abstract

Background/Purpose: The purpose of this study was to review the authors' 25-year experience with redo pull-through procedures for Hirschsprung's disease including surgical technique and long-term outcome. Methods: From 1974 to now, over 325 patients with Hirschsprung's disease have been treated at C.S. Mott Children's Hospital. This includes 30 patients referred after an unsuccessful pull-through at another hospital and 2 patients with an unsuccessful pull-through from C.S. Mott. All redo pull-throughs (n = 19) were performed in these patients, and their clinical courses are reviewed. Results: Twelve patients required reoperation secondary to a mechanical problem with their first pull-through. The other 7 patients had evidence of residual segments of dilated colon leading to functional failure of their initial operation including 5 patients with documented aganglionic bowel present at the second pull-through. Ten of the patients requiring reoperation initially had an endorectal pull-through (ERPT), 5 had a Duhamel procedure, 3 had a Swenson procedure, and 1 had a Rehbein procedure. Choice of revision was an ERPT in 8 patients in whom an adequate rectal cuff could be developed. Additional redo procedures included a Duhamel in 8 patients and a Swenson in 3 patients. Follow-up ranges from 3 months to 23 years (mean, 13.8 years). There were no deaths in the series, and 1 patient required a third pull-through. All patients who are not neurologically impaired and are over age 3 are continent except one (94%). Stools per day range from 1 to 10 (mean, 3.2). Conclusions: Redo pull-through operations for Hirsch-sprung's disease appear to be as effective as primary procedures in terms of continence and stooling frequency. Distinct from other series, we found an ERPT to be the procedure of choice if an adequate rectal cuff was present. J Pediatr Surg 35:829-834. Copyright © 2000 by W.B. Saunders Company.

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).

. Redo Pull-Through Series

StudyYearNo. of CasesInitial ProcedureRedo

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  • Cited by (0)

    Address reprint requests to Arnold G. Coran, MD, Section of Pediatric Surgery, University of Michigan Hospitals, Mott F3970, Box 0245, Ann Arbor, MI 48109.

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