title: Redo pull-through surgery in Hirschsprung disease: Short-term clinical outcome.
abstract: BACKGROUND
  Although surgery is effective in most patients with Hirschsprung disease (HD), some have persistent obstructive symptoms. Additional medical treatment is generally sufficient, but a small fraction of these patients needs secondary surgery. Series on redo surgery are scarce. Aim of this study is to evaluate complications and clinical outcome of patients in need of redo surgery for HD.
  
  
  METHODS
  Sixteen patients underwent redo endorectal pull-through surgery in our center between 2007 and 2015. Medical records were reviewed and demographics, indication for redo surgery, surgical procedures, complications, and clinical outcome were scored.
  
  
  RESULTS
  The median age at the time of redo was 4.6years (range: 2months-21years). Median follow-up after redo was 3years (range: 9months-7years). Before redo surgery, all patients (100%) had obstructive symptoms, one patient had recurrent enterocolitis, and four patients were fecally incontinent despite adequate attempts of bowel management. Surgical procedure consisted of a transanal endorectal pull-through (TERPT) in all patients, with additional laparotomy in 7 (44%) and protective stoma in 8 patients (50%). Complications within 30days after redo surgery were anastomotic dehiscence (3; 19%), wound abscess (2; 13%), rectovaginal fistula (1; 7%) or enterocutaneous fistula (1; 7%). During follow-up, nine patients needed additional surgery, mainly to close the stoma. At final follow-up there were no patients with stenosis, obstructive symptoms, remaining rectovaginal fistula, or small bowel obstruction. Only one patient experienced enterocolitis. Six patients (43%) reported soiling or fecal incontinence.
  
  
  CONCLUSIONS
  TERPT for redo surgery for HD is effective in resolving sustained severe obstructive symptoms after primary surgery, but the outcome is complicated by a relatively high rate of soiling and fecal incontinence.
authors.affiliation: Department of Surgery - Division of Pediatric Surgery, Radboudumc-Amalia Children's Hospital, Nijmegen, The Netherlands.
authors.forename: Ajm
authors.initials: A
authors.lastname: Dingemans
authors.affiliation: Department of Surgery - Division of Pediatric Surgery, Radboudumc-Amalia Children's Hospital, Nijmegen, The Netherlands.
authors.forename: Hjj
authors.initials: H
authors.lastname: van der Steeg
authors.affiliation: Department of Surgery - Division of Pediatric Surgery, Radboudumc-Amalia Children's Hospital, Nijmegen, The Netherlands.
authors.forename: R
authors.initials: R
authors.lastname: Rassouli-Kirchmeier
authors.affiliation: Department of Surgery - Division of Pediatric Surgery, Radboudumc-Amalia Children's Hospital, Nijmegen, The Netherlands.
authors.forename: M W
authors.initials: MW
authors.lastname: Linssen
authors.affiliation: Radboud Institute for Health Sciences, Department for Health Evidence, Radboudumc, Nijmegen, The Netherlands.
authors.forename: Ialm
authors.initials: I
authors.lastname: van Rooij
authors.affiliation: Department of Surgery - Division of Pediatric Surgery, Radboudumc-Amalia Children's Hospital, Nijmegen, The Netherlands. Electronic address: ivo.deblaauw@radboudumc.nl.
authors.forename: I
authors.initials: I
authors.lastname: de Blaauw
mesh_terms: D000293:Adolescent; D001003:Anal Canal / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D013505:Digestive System Surgical Procedures / Q000009:adverse effects* / Q000379:methods; D004760:Enterocolitis / Q000209:etiology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006627:Hirschsprung Disease / Q000601:surgery*; D006801:Humans; D007223:Infant; D007415:Intestinal Obstruction / Q000209:etiology / Q000601:surgery*; D008297:Male; D011183:Postoperative Complications / Q000209:etiology; D012006:Rectovaginal Fistula / Q000209:etiology / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult
keywords: Hirschsprung disease; Redo pull-through; Redo surgery; TERPT; Transition zone