Redo surgery in Hirschsprung disease: what did we learn? Unicentric experience on 70 patients

J Pediatr Surg. 2010 Apr;45(4):747-54. doi: 10.1016/j.jpedsurg.2009.08.001.

Abstract

Purpose: This article is aimed at describing a series of 70 patients who underwent a redo pull-through in the period between January 1991 and January 2007 and to compare them with a series of consecutive patients with Hirschsprung disease who underwent a single pull-through.

Methods: The notes were reviewed, and a comprehensive interview based on a disease-specific questionnaire for continence and quality of life was submitted to all eligible patients. We used a number of consecutive patients who underwent a single pull-through for Hirschsprung disease as control group.

Results: Seventy patients were included. Residual aganglionosis in pulled-through bowel or retained aganglionic rectum represented the indications to reoperation in most cases. Intestinal obstruction represented the leading symptom in more than 60% of patients. We adopted either the endorectal pull-through, the Duhamel, or the Swenson procedure. Thirty-six patients were assessed for long-term outcome. One third experienced complications. Long-term continence was satisfactory in 70%. Enterocolitis, soiling, and perineal excoriations were complained by 30%. Excellent to good perspectives were described by 94%, and excellent to good cosmetic results by 22%. The only significant difference with control group (109 patients) involved cosmetic appearance, whereas soiling, although more frequent, could not be considered significantly increased.

Conclusions: Patients who experience failure of a pull-through must go through multiple procedures to achieve definitive results. Although overall outcome does not significantly differ from that of a single effective pull-through, great efforts should be made to minimize complications and avoid the need for a redo, which requires experienced surgeons and highly committed families for a longer course of the disease.

MeSH terms

  • Case-Control Studies
  • Child, Preschool
  • Digestive System Surgical Procedures / methods
  • Female
  • Follow-Up Studies
  • Hirschsprung Disease / surgery*
  • Humans
  • Male
  • Postoperative Complications*
  • Quality of Life
  • Reoperation
  • Treatment Failure