Redo-endorectal pull through following various pull through procedures in Hirschsprung's disease.
BACKGROUND
The purpose of this study was to analyse the outcome of redo-endorectal pull through in Hirschsprung's disease following different original pull through procedures. In the past, redo-endorectal pull through was mainly performed following endorectal pull through, but not following the Duhamel procedure. We present the outcome of eight patients after redo-endorectal pull through, including five who underwent Duhamel pull through as original procedure.


METHODS
Between 2002 and 2004, eight patients underwent redo-endorectal pull through following the Duhamel procedure (five), Rehbein procedure (one) and endorectal pull through (two). A retrospective study was performed to evaluate the clinical course after redo-endorectal pull through, reviewing inpatients' and outpatients' charts and performing standardised interviews.


RESULTS
Four of eight patients had normal stool pattern after redo-endorectal pull through. In two patients mild and in another two patients severe chronic constipation occurred after redo-surgery. Constipation-associated incontinence was noted in four patients, which is terminated after initiation of laxative treatment in three. Enterocolitis occurred in one patient and recurrent ileitis in another child with total colonic aganglionosis. No impairment of bladder function was observed after redo-endorectal pull through.


CONCLUSIONS
Redo-endorectal pull through proved to be a safe technique and feasible even after prior Duhamel pull through, resulting in good clinical outcome.
Obermayr
Florian
F
Department of Paediatric Surgery, University of Tuebingen, Tuebingen, Germany. florian.obermayr@med.uni-tuebingen.de
Hacker
Hans-Walter
HW
Bornemann
Antje
A
Stern
Martin
M
Fuchs
Jörg
J
D002648:Child; D002675:Child, Preschool; D003248:Constipation / Q000601:surgery; D004760:Enterocolitis / Q000601:surgery; D005242:Fecal Incontinence / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006627:Hirschsprung Disease / Q000601:surgery*; D006801:Humans; D007223:Infant; D007415:Intestinal Obstruction / Q000601:surgery; D008297:Male; D011183:Postoperative Complications / Q000601:surgery*; D012007:Rectum / Q000601:surgery*; D012086:Reoperation; D012189:Retrospective Studies; D013536:Suture Techniques