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

Alessio Pini-Prato, Girolamo Mattioli, Camilla Giunta, Stefano Avanzini, Paolo Magillo, Giovanni Maria Bisio, Vincenzo Jasonni

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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.

Original languageEnglish
Pages (from-to)747-754
Number of pages8
JournalJournal of Pediatric Surgery
Volume45
Issue number4
DOIs
Publication statusPublished - Apr 2010

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Keywords

  • Complications
  • Hirschsprung
  • Outcome
  • Pull-through
  • Redo

ASJC Scopus subject areas

  • Surgery
  • Pediatrics, Perinatology, and Child Health

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