KMID : 0605920040100010001
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Journal of Korean Association of Pediatric Surgeons 2004 Volume.10 No. 1 p.1 ~ p.8
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Re-pull-through Operation in Hirschsprung¢¥s Disease
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Kim Hyun-Young
Park Kwi-Won Chun Yong-Soon Jung Sung-Eun Lee Seong-Cheol Kim Woo-Ki
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Abstract
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A re-pull-through operation for Hirschsprung¡¯s disease is performed when the primary operation has failed because of the remnant or acquired aganglionosis, anastomotic stricture and/or fistula. The purpose of this study is to review our experience of the re-pull-through procedure for Hirschsprung¡¯s disease. From May 1978 to July 2003, 26 patients who underwent re-pull-through operations at the Department of Pediatric Surgery, Seoul National University Children¡¯s Hospital, were studied retrospectively by means of chart review as well as telephone interview. The mean age at primary operation and re-operation were 11months (2 months - 10 years) and 43 months (1 year - 23 years 3 months), respectively. Initial operation for Hirschsprung¡¯s disease was Duhamel¡¯s procedure in 17, Swenson¡¯s in 6 and Soave¡¯s 3. Causes of failure of primary operation were remains of secondary aganglionic segment (n=23), vascular arcade injury (n=1), rectoperineal fistula (n=2, due to mesenteric torsion and poor blood supply). Mean interval between the primary operation and the re-operation was 34 months (6 months-22 years). Reoperation methods were Soave¡¯s in 12, Duhamel¡¯s in 8, APSP (abdomino-posterosagittal pull-through procedure) in 5, and Swenson¡¯s in 1 case. In 2 cases of repeated rectoperineal fistula or rectourethral fistula, re-APSP were performed 3 times, respectively. A total of 29 re-pull-through operations were performed. Postoperative complications were wound infection (n=1), adhesive ileus (n=1), rectoperineal fistula (n=3), rectourethral fistula (n=2), and death due to pulmonary embolism (n=1). Mean follow up period of reoperation was 78 months (1 month-23years). In current state, 2 patients have an ileostomy because of repeated rectoperineal fistula and rectourethral fistula. Of the remaining 23 patients, 21(91 %) are totally continent with or without minimal soiling. Reoperation for Hirschsprung¡¯s disease was effective and safe for the patients complicated to the initial pull-through operation.
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KEYWORD
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Hirschsprung¢¥s disease, Reoperation, Cause of failure
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