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Eur J Pediatr Surg 2019; 29(05): 431-436
DOI: 10.1055/s-0038-1667038
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Why Do the Patients with Hirschsprung Disease Get Redo Pull-Through Operation?

Ji-Won Han
1   Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
,
Joong Kee Youn
2   Department of Pediatric Surgery, Seoul National University Children's Hospital, Seoul, Republic of Korea
,
Chaeyoun Oh
3   Department of General Surgery, Korea University Anam Hospital, Seoul, Republic of Korea
,
Hyun-Young Kim
2   Department of Pediatric Surgery, Seoul National University Children's Hospital, Seoul, Republic of Korea
,
Sung-Eun Jung
2   Department of Pediatric Surgery, Seoul National University Children's Hospital, Seoul, Republic of Korea
,
Kwi-Won Park
4   Department of Surgery, Chung Ang University Hospital, Seoul, Republic of Korea
› Author Affiliations
Further Information

Publication History

26 March 2018

04 June 2018

Publication Date:
01 August 2018 (online)

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Abstract

Introduction The treatment of Hirschsprung disease (HD) is pull-through (PT) surgery. Redo PT can be performed in 1 to 10% of patients after initial PT. In this study, we reviewed the causes and associated factors of redo PT.

Materials and Methods We retrospectively reviewed medical charts of 657 patients with HD who underwent surgeries between September 1979 and January 2016. The indications for redo PT are as follows. First, there were persistent obstructive symptoms after the first operation, (1) with transition zone shown definitely on contrast study, (2) with anatomic problems, and (3) obstructive symptoms persist despite conservative or nonredo surgical treatment without (1) and (2). We analyzed the causes and associated factors of redo PT.

Results A total of 49 (7.5%) patients underwent redo PT. Among them, 41 and 8 patients underwent PT twice and three times, respectively. Among 57 cases of redo, the causes of redo included pathologic problem (n = 28)—aganglionosis (n = 20), hypoganglionosis (n = 4), immature ganglion cell (n = 4)—or anatomic problem (n = 21)—stricture (n = 13), fistula and/or abscess (n = 8) at anastomosis. Comparing associated factors between the nonredo and redo groups, the redo group had longer initial PT operation time (p = 0.001), more postoperative complications (p < 0.001), and more transanal endorectal PT (TERPT) approach as initial PTs (p < 0.001). According to causes of redo, the anatomic problem group underwent more third PTs than the pathologic problem group (p = 0.010).

Conclusion Approximately 7.5% of patients experienced redo PT. The cause of redo included pathologic (n = 28) or anatomic problem (n = 21). Longer operation time, more complications, and TERPT were associated with redo. The anatomic problem group underwent more third PTs than the pathologic problem group.

Keywords

colorectal - pediatric - gastrointestinal - Hirschsprung disease

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required.


 

  • Reference

  • 1 Cogbill TH, Lilly JR. Acquired aganglionosis after Soave's procedure for Hirschsprung's disease. Arch Surg 1982; 117 (10) 1346-1347
    PubMedGoogle Scholar
  • 2 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
    CrossrefPubMedGoogle Scholar
  • 3 Ralls MW, Coran AG, Teitelbaum DH. Reoperative surgery for Hirschsprung disease. Semin Pediatr Surg 2012; 21 (04) 354-363
    CrossrefPubMedGoogle Scholar
  • 4 Shayan K, Smith C, Langer JC. Reliability of intraoperative frozen sections in the management of Hirschsprung's disease. J Pediatr Surg 2004; 39 (09) 1345-1348
    CrossrefPubMedGoogle Scholar
  • 5 Dasgupta R, Langer JC. Evaluation and management of persistent problems after surgery for Hirschsprung disease in a child. J Pediatr Gastroenterol Nutr 2008; 46 (01) 13-19
    CrossrefPubMedGoogle Scholar
  • 6 Schweizer P, Berger S, Schweizer M, Holschneider AM, Beck O. Repeated pull-through surgery for complicated Hirschsprung's disease--principles derived from clinical experience. J Pediatr Surg 2007; 42 (03) 536-543
    CrossrefPubMedGoogle Scholar
  • 7 Kapur RP. Histology of the transition zone in Hirschsprung disease. Am J Surg Pathol 2016; 40 (12) 1637-1646
    CrossrefPubMedGoogle Scholar
  • 8 Dasgupta R, Langer JC. Transanal pull-through for Hirschsprung disease. Semin Pediatr Surg 2005; 14 (01) 64-71
    CrossrefPubMedGoogle Scholar
  • 9 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
    CrossrefPubMedGoogle Scholar
  • 10 Dingemans A, van der Steeg H, Rassouli-Kirchmeier R, Linssen MW, van Rooij I, de Blaauw I. Redo pull-through surgery in Hirschsprung's disease: short-term clinical outcome. J Pediatr Surg 2017; 52 (09) 1446-1450
    CrossrefPubMedGoogle Scholar
  • 11 Ehrenpreis T. Acquired megacolon as a complication of recto-sigmoidectomy for Hirschsprung's disease. Arch Dis Child 1965; 40: 180-182
    CrossrefPubMedGoogle Scholar
  • 12 Bag MJ, Sáez T, Varas J. , et al. Surgical acquired aganglionosis: myth or reality?. Pediatr Surg Int 2014; 30 (08) 797-802
    CrossrefPubMedGoogle Scholar
  • 13 Bischoff A, Levitt MA, Peña A. Total colonic aganglionosis: a surgical challenge. How to avoid complications?. Pediatr Surg Int 2011; 27 (10) 1047-1052
    CrossrefPubMedGoogle Scholar
  • 14 Cohen MC, Moore SW, Neveling U, Kaschula RO. Acquired aganglionosis following surgery for Hirschsprung's disease: a report of five cases during a 33-year experience with pull-through procedures. Histopathology 1993; 22 (02) 163-168
    CrossrefPubMedGoogle Scholar
  • 15 Inoue K, Shimotake T, Tomiyama H, Iwai N. Mutational analysis of the RET and GDNF gene in children with hypoganglionosis. Eur J Pediatr Surg 2001; 11 (02) 120-123
    Article in Thieme ConnectPubMedGoogle Scholar
  • 16 Friedmacher F, Puri P. Classification and diagnostic criteria of variants of Hirschsprung's disease. Pediatr Surg Int 2013; 29 (09) 855-872
    CrossrefPubMedGoogle Scholar
  • 17 Yang H-B, Kim H-Y, Kim S-H. , et al. Prevalence and significance of immature ganglion cell in Hirschsprung's disease. J Korean Assoc Pediatr Surg 2013; 18 (02) 122-129
    PubMedGoogle Scholar
  • 18 Seo S, Miyake H, Hock A. , et al. Duhamel and transanal endorectal pull-throughs for Hirschsprung' disease: a systematic review and meta-analysis. Eur J Pediatr Surg 2018; 28 (01) 81-88
    Article in Thieme ConnectPubMedGoogle Scholar
  • 19 van de Ven TJ, Sloots CE, Wijnen MH. , et al. Transanal endorectal pull-through for classic segment Hirschsprung's disease: with or without laparoscopic mobilization of the rectosigmoid?. J Pediatr Surg 2013; 48 (09) 1914-1918
    CrossrefPubMedGoogle Scholar
  • 20 De La Torre L, Langer JC. Transanal endorectal pull-through for Hirschsprung disease: technique, controversies, pearls, pitfalls, and an organized approach to the management of postoperative obstructive symptoms. Semin Pediatr Surg 2010; 19 (02) 96-106
    CrossrefPubMedGoogle Scholar
  • 21 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
    CrossrefPubMedGoogle Scholar
  • 22 Ralls MW, Coran AG, Teitelbaum DH. Redo pull-through for Hirschsprung disease. Pediatr Surg Int 2017; 33 (04) 455-460
    CrossrefPubMedGoogle Scholar