Subscribe to RSS
Redo Transanal Soave Pull Through with or without Assistance in Hirschsprung Disease: An Experience in 46 Patients
Introduction Transanal Soave pull through (PT) with or without assistance can be performed as a redo procedure for Hirschsprung disease (HD). In this study, we reviewed the indications and clinical outcomes of redo transanal Soave with or without assistance.
Materials and Methods A retrospective analysis was performed on patients who underwent redo transanal Soave with or without assistance in our hospital from 2004 to 2016, and did not have rectourethral fistula or rectovaginal fistula. The Krickenbeck classification system was used to evaluate postoperative bowel function. We analyzed the associated factors of the two main indications.
Results In this study, 46 patients were included, representing 5.6% of all HD PTs; 42 patients were initially operated elsewhere and 4 at our hospital. Primary PT surgeries included 38 transanal Soave, 2 Rehbein, 1 Martin, and 5 unknown procedures. The indications for redo PT were residual aganglionosis/transition zone PT (RA/TZPT) (27, 58.7%), anastomotic complication (14, 30.4%), and dilated distal segment (5, 10.9%). The median age of these 46 patients at primary and redo PT was 7.0 months (range, 0.4–137 months) and 45.5 months (range, 7–172 months), respectively. All 46 patients underwent redo transanal Soave PT; 43 patients (93.5%) underwent transanal Soave with laparotomy (n = 42) or laparoscopy (n = 1), and another 3 patients underwent transanal Soave PT. Six patients (13%) experienced complications within 30 days after redo surgery. A total of 43 patients were followed up, and the median follow-up period was 100 months (range, 35–180 months). Two patients could not hold back defecation in some inconvenient conditions. Sixteen patients (37.2%) had soiling, and 8 (18.6%) of 16 patients complained frequent soiling occurrence (more than 1/week). Only one patient complained of constipation (grade 1). Patients with anastomotic complication had more early postoperative complication and higher rate of soiling than patients with RA/TZPT, but there was no statistical difference (p = 0.672 and p = 0.105).
Conclusion Transanal Soave PT with or without assistance was effective in resolving different problems after initial PT, while soiling was the most common postoperative problem, especially patients with anastomotic complication.
Received: 08 November 2019
Accepted: 27 March 2020
26 May 2020 (online)
© 2020. Thieme. All rights reserved.
Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany
- 1 Levitt MA, Dickie B, Peña A. Evaluation and treatment of the patient with Hirschsprung disease who is not doing well after a pull-through procedure. Semin Pediatr Surg 2010; 19 (02) 146-153
- 2 Friedmacher F, Puri P. Residual aganglionosis after pull-through operation for Hirschsprung's disease: a systematic review and meta-analysis. Pediatr Surg Int 2011; 27 (10) 1053-1057
- 3 Peña A, Elicevik M, Levitt MA. Reoperations in Hirschsprung disease. J Pediatr Surg 2007; 42 (06) 1008-1013
- 4 Ralls MW, Freeman JJ, Rabah R. et al. Redo pullthrough for Hirschsprung disease: a single surgical group's experience. J Pediatr Surg 2014; 49 (09) 1394-1399
- 5 van Leeuwen K, Teitelbaum DH, Elhalaby EA, Coran AG. Long-term follow-up of redo pull-through procedures for Hirschsprung's disease: efficacy of the endorectal pull-through. J Pediatr Surg 2000; 35 (06) 829-833
- 6 Garrett KM, Levitt MA, Peña A, Kraus SJ. Contrast enema findings in patients presenting with poor functional outcome after primary repair for Hirschsprung disease. Pediatr Radiol 2012; 42 (09) 1099-1106
- 7 Holschneider A, Hutson J, Peña A. et al. Preliminary report on the international conference for the development of standards for the treatment of anorectal malformations. J Pediatr Surg 2005; 40 (10) 1521-1526
- 8 Clavien PA, Barkun J, de Oliveira ML. et al. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg 2009; 250 (02) 187-196
- 9 Dingemans A, van der Steeg H, Rassouli-Kirchmeier R, Linssen MW, van Rooij I, de Blaauw I. Redo pull-through surgery in Hirschsprung disease: short-term clinical outcome. J Pediatr Surg 2017; 52 (09) 1446-1450
- 10 Lawal TA, Chatoorgoon K, Collins MH, Coe A, Peña A, Levitt MA. Redo pull-through in Hirschsprung's [corrected] disease for obstructive symptoms due to residual aganglionosis and transition zone bowel. J Pediatr Surg 2011; 46 (02) 342-347
- 11 Pini-Prato A, Mattioli G, Giunta C. et al. Redo surgery in Hirschsprung disease: what did we learn? Unicentric experience on 70 patients. J Pediatr Surg 2010; 45 (04) 747-754
- 12 Zani A, Eaton S, Morini F. et al; EUPSA Network Office. European Paediatric Surgeons' Association survey on the management of Hirschsprung disease. Eur J Pediatr Surg 2017; 27 (01) 96-101
- 13 Ralls MW, Coran AG, Teitelbaum DH. Reoperative surgery for Hirschsprung disease. Semin Pediatr Surg 2012; 21 (04) 354-363
- 14 Ralls MW, Coran AG, Teitelbaum DH. Redo pullthrough for Hirschsprung disease. Pediatr Surg Int 2017; 33 (04) 455-460
- 15 Stensrud KJ, Emblem R, Bjørnland K. Late diagnosis of Hirschsprung disease--patient characteristics and results. J Pediatr Surg 2012; 47 (10) 1874-1879
- 16 Levitt MA, Hamrick MC, Eradi B, Bischoff A, Hall J, Peña A. Transanal, full-thickness, Swenson-like approach for Hirschsprung disease. J Pediatr Surg 2013; 48 (11) 2289-2295
- 17 Shahjahan M, Ferdous MN, Nag UK, Ullah MS, Rahman MA, Islam MK. Outcome of single-stage transanal endorectal pull through for short segment Hirschsprung's disease in neonates and infants. Mymensingh Med J 2014; 23 (01) 69-74
- 18 Hüser N, Michalski CW, Erkan M. et al. Systematic review and meta-analysis of the role of defunctioning stoma in low rectal cancer surgery. Ann Surg 2008; 248 (01) 52-60
- 19 Sun S, Chen G, Zheng S, Dong K, Xiao X. Usefulness of posterior sagittal anorectoplasty for redo pull-through in complicated and recurrent Hirschsprung disease: experience with a single surgical group. J Pediatr Surg 2017; 52 (03) 458-462
- 20 Sheng Q, Lv Z, Xiao X. Re-operation for Hirschsprung's disease: experience in 24 patients from China. Pediatr Surg Int 2012; 28 (05) 501-506
- 21 Coe A, Collins MH, Lawal T, Louden E, Levitt MA, Peña A. Reoperation for Hirschsprung disease: pathology of the resected problematic distal pull-through. Pediatr Dev Pathol 2012; 15 (01) 30-38
- 22 Pucciani F. Faecal soiling: pathophysiology of postdefaecatory incontinence. Colorectal Dis 2013; 15 (08) 987-992