Reoperations in Hirschsprung disease.
BACKGROUND
We sought to identify causes of preventable complications related to operations for Hirschsprung disease.


METHODS
We reviewed the cases of 51 patients with Hirschsprung disease who underwent a primary procedure elsewhere, had a complication, and were referred for reoperation.


RESULTS
Thirty-five patients had 1 failed operation, 10 had 2, and 6 had 3. Initial operations were Soave (20), Duhamel (15), Swenson (5), transanal endorectal (4), myectomy (3), unknown (3), and laparoscopic Swenson (1). Thirty-one patients presented with a stoma. Patients without a stoma (20) had fecal impaction (8), recurrent enterocolitis (6), and fecal incontinence (6). None had both enterocolitis and incontinence. Reoperation was performed posterior sagittally (40) or transanally (5). Indications included stricture (21), megarectal Duhamel pouches (12), fistulae (11 [8 rectocutaneous, 2 rectourethral, and 1 rectovaginal]), pouchitis (2), and retained aganglionic bowel (8). After reoperation, 14 were continent, 11 had a stoma (8 permanent), 6 had voluntary bowel movements but soiled occasionally, 6 received rectal irrigations to avoid enterocolitis, 6 were incontinent but clean with bowel management, and 2 were lost to follow-up.


CONCLUSIONS
Stricture, megarectal pouch, fistula, and retained aganglionic bowel are preventable complications. Enterocolitis is partially preventable but can occur after a technically correct procedure. Fecal incontinence is a preventable complication likely because of anal canal damage.
Peña
Alberto
A
Department of Pediatric Surgery, Colorectal Center for Children, Cincinnati Children's Hospital, Cincinnati, OH 45229, USA. alberto.pena@cchmc.org
Elicevik
Mehmet
M
Levitt
Marc A
MA
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D003251:Constriction, Pathologic; D013505:Digestive System Surgical Procedures / Q000379:methods / Q000706:statistics & numerical data; D004760:Enterocolitis / Q000209:etiology / Q000517:prevention & control / Q000601:surgery; D005242:Fecal Incontinence / Q000209:etiology / Q000517:prevention & control / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006627:Hirschsprung Disease / Q000601:surgery*; D006801:Humans; D007223:Infant; D007410:Intestinal Diseases / Q000209:etiology / Q000601:surgery; D007412:Intestinal Fistula / Q000209:etiology / Q000517:prevention & control / Q000601:surgery; D008297:Male; D011183:Postoperative Complications / Q000517:prevention & control / Q000601:surgery; D011788:Quality of Life; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D054047:Surgical Stomas