title: Laparoscopy-assisted versus transabdominal reoperation in Hirschprung's disease for residual aganglionosis and transition zone pathology after transanal pull-through.
abstract: BACKGROUND
  This study aims to describe laparoscopic reoperation (LSR) and compare its outcomes with transabdominal reoperation (TAR) for treating Hirschsprung's disease (HD).
  
  
  METHODS
  Eighteen patients with HD underwent reoperation for recurring constipation due to residual aganglionosis and transition zone pathology after an initial transanal procedure (LSR, n=10; TAR, n=8). Preoperative, operative and postoperative data were collected through patient follow-ups ranging from 13 to 75months to compare operative characteristics and postoperative outcomes between the two groups.
  
  
  RESULTS
  Ten patients underwent laparoscopic reoperation in our institution without major complications. On average, blood loss was significantly lower in the LSR group (mean±standard deviation, 83±32.7mL) than in the TAR group (185±69mL) (P=0.001). The LSR group had a shorter hospitalization time (12±2days) than the TAR group (15±2.1days) (P=0.02). There was no statistically significant difference in incidence of postoperative complications between the two groups.
  
  
  CONCLUSIONS
  LSR is safe and technically feasible in HD for recurring constipation due to residual aganglionosis and transition zone pathology, when initial transanal procedure fails. Although RA and TZP can be cured by reoperation, great efforts should be made to diminish the necessity of reoperation.
authors.affiliation: Department of Pediatric Surgery, Tongji Hospital, 1095 Jiefang Avenue, Wuhan 430030, China. Electronic address: xiaxue1106@163.com.
authors.forename: Xue
authors.initials: X
authors.lastname: Xia
authors.affiliation: Department of Pediatric Surgery, Tongji Hospital, 1095 Jiefang Avenue, Wuhan 430030, China.
authors.forename: Ning
authors.initials: N
authors.lastname: Li
authors.affiliation: Department of Pediatric Surgery, Tongji Hospital, 1095 Jiefang Avenue, Wuhan 430030, China.
authors.forename: Jia
authors.initials: J
authors.lastname: Wei
authors.affiliation: Department of Pediatric Surgery, Tongji Hospital, 1095 Jiefang Avenue, Wuhan 430030, China.
authors.forename: Wen
authors.initials: W
authors.lastname: Zhang
authors.affiliation: Department of Pediatric Surgery, Tongji Hospital, 1095 Jiefang Avenue, Wuhan 430030, China.
authors.forename: Donghai
authors.initials: D
authors.lastname: Yu
authors.affiliation: Department of Pediatric Surgery, Tongji Hospital, 1095 Jiefang Avenue, Wuhan 430030, China.
authors.forename: Tianqi
authors.initials: T
authors.lastname: Zhu
authors.affiliation: Department of Pediatric Surgery, Tongji Hospital, 1095 Jiefang Avenue, Wuhan 430030, China. Electronic address: 583821997@qq.com.
authors.forename: Jiexiong
authors.initials: J
authors.lastname: Feng
mesh_terms: D016063:Blood Loss, Surgical; D003248:Constipation / Q000209:etiology; D005260:Female; D006627:Hirschsprung Disease / Q000473:pathology / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay; D008099:Liver / Q000473:pathology; D008297:Male; D011183:Postoperative Complications; D011184:Postoperative Period; D012086:Reoperation / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Constipation recurrences; Hirschsprung’s disease; Laparoscopic reoperation; Outcomes; Transabdominal reoperation; Transition zone pathology