Redo surgery in Hirschsprung disease: what did we learn? Unicentric experience on 70 patients.
OBJECTIVE
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.
Pini-Prato
Alessio
A
Department of Pediatric Surgery - G. Gaslini Institute, Largo G. Gaslini, 5, 16147 Genoa, Italy. alessiopiniprato@ospedale-gaslini.ge.it
Mattioli
Girolamo
G
Giunta
Camilla
C
Avanzini
Stefano
S
Magillo
Paolo
P
Bisio
Giovanni Maria
GM
Jasonni
Vincenzo
V
D016022:Case-Control Studies; D002675:Child, Preschool; D013505:Digestive System Surgical Procedures / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006627:Hirschsprung Disease / Q000601:surgery*; D006801:Humans; D008297:Male; D011183:Postoperative Complications; D011788:Quality of Life; D012086:Reoperation; D017211:Treatment Failure