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Surgical approach and functional outcome of redo pull-through for postoperative complications in Hirschsprung’s disease

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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.

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Funding

Beijing Municipal Administration of Hospitals Incubating Program, Code: PX2020054.

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Authors and Affiliations

  1. Department of General Surgery, Capital Institute of Pediatrics, Beijing, China

    Qi Li, Zhen Zhang & Long Li

  2. Department of Medical Genetics, Capital Institute of Pediatrics, Beijing, China

    Qian Jiang

  3. Department of Radiology, Capital Institute of Pediatrics, Beijing, China

    Yuchun Yan

  4. Department of Pathology, Capital Institute of Pediatrics, Beijing, China

    Ping Xiao

  5. Department of Ultrasound, Capital Institute of Pediatrics, Beijing, China

    Ya Ma

  6. Department of Pediatric Surgery, KK Women’s and Children’s Hospital, Singapore, Singapore

    Yee Low

Authors
  1. Qi Li
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  2. Zhen Zhang
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  3. Ping Xiao
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  4. Ya Ma
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  5. Yuchun Yan
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  6. Qian Jiang
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  8. Long Li
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Corresponding author

Correspondence to Long Li.

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The authors have no conflict of interest to disclose.

Research involving human participants

Ethical approval was obtained from the Ethics Committee of the Capital Institute of Pediatrics.

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Written informed consents were obtained from the parents before surgery.

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Cite this article

Li, Q., Zhang, Z., Xiao, P. et al. Surgical approach and functional outcome of redo pull-through for postoperative complications in Hirschsprung’s disease. Pediatr Surg Int 37, 1401–1407 (2021). https://doi.org/10.1007/s00383-021-04965-4

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  • DOI: https://doi.org/10.1007/s00383-021-04965-4

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