title: Usefulness of posterior sagittal anorectoplasty for redo pull-through in complicated and recurrent Hirschsprung disease: Experience with a single surgical group.
abstract: OBJECTIVE
  To retrospectively examine 12 patients with Hirschsprung disease (HD) who underwent posterior sagittal anorectoplasty (PSARP) for various complications.
  
  
  METHODS
  This study included patients with HD who underwent redo pull-through (PT) via PSARP at our institute between 2005 and 2014. The type of initial procedure, clinical presentations, indications, and functional results were analyzed. Postoperative excretory function was assessed using the Krickenbeck classification.
  
  
  RESULTS
  The study group comprised 9 boys and 3 girls (total, 12). Five patients were diagnosed with rectosigmoid aganglionosis, 5 with long segment aganglionosis, and 2 with total colonic aganglionosis. The primary operations performed on these patients included the Soave, Duhamel, Swenson, Rehbein, and Ikeda-Soper procedures. The interval between the primary operations and reoperation ranged from 5months to 8years (median, 3years). The indications for PSARP were rectocutaneous fistulae (6 cases), frozen pelvis (5 cases), severe anastomotic stricture (3 cases), rectovaginal fistulae (2 cases), and hemorrhagic proctitis with an inflammatory polyp (1 case). All fistulae were repaired using PSARP; only one rectocutaneous fistula recurred and required two additional surgeries. Stricture and hemorrhagic proctitis were cured in all involved cases. Nine patients were followed up for 8months to 10years after PSARP surgery (average, 5.1years). All 9 patients had voluntary bowel movements within 6months after the last PSARP and stoma closure: 3 had normal bowel movement, while 6 had varying degrees of soiling, depending on the length of residual colon. None complained of constipation.
  
  
  CONCLUSIONS
  PSARP is useful for treating severe complications of failed PT in HD. Complex and recurrent rectocutaneous fistulae and frozen pelvis are the main indications for PSARP, while soiling is the most common surgical complication.
authors.affiliation: Department of Surgery, Children's Hospital of Fudan University, Shanghai 201102, China.
authors.forename: Song
authors.initials: S
authors.lastname: Sun
authors.affiliation: Department of Surgery, Children's Hospital of Fudan University, Shanghai 201102, China.
authors.forename: Gong
authors.initials: G
authors.lastname: Chen
authors.affiliation: Department of Surgery, Children's Hospital of Fudan University, Shanghai 201102, China. Electronic address: szheng@shmu.edu.cn.
authors.forename: Shan
authors.initials: S
authors.lastname: Zheng
authors.affiliation: Department of Surgery, Children's Hospital of Fudan University, Shanghai 201102, China.
authors.forename: Kuiran
authors.initials: K
authors.lastname: Dong
authors.affiliation: Department of Surgery, Children's Hospital of Fudan University, Shanghai 201102, China.
authors.forename: Xianmin
authors.initials: X
authors.lastname: Xiao
mesh_terms: D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006627:Hirschsprung Disease / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011183:Postoperative Complications / Q000601:surgery*; D011859:Radiography; D019651:Plastic Surgery Procedures / Q000009:adverse effects*; D012003:Rectal Fistula / Q000209:etiology / Q000601:surgery; D012006:Rectovaginal Fistula / Q000209:etiology / Q000601:surgery; D012007:Rectum / Q000601:surgery; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies
keywords: Hirschsprung disease; Posterior sagittal anorectoplasty; Redo pull-through