Reoperative experience and efficacy of Hirschsprung disease:a 20-year single-center study
Objective To explore the causes of reoperation in children after operation for Hirschsprung disease(HSCR)and to summarize the clinical experiences and outcomes of reoperation.Methods From January 2000 to December 2019,the relevant clinical data were retrospectively reviewed for 151 HSCR children undergoing reoperation.The causes,operative approaches and follow-up results of reoperation were summarized.Based upon age of initial operation,they were assigned into two groups of ≤3-month(n=8)and＞3-month(n=143).Chi-square test was utilized for comparing the inter-group differences in gender,initial operative approach,pathological classification of HSCR,reoperative causes and reoperative mode.Results Among them,97 cases(97/151,64.24％)were reoperated for recurrent constipation.Other causes included fecal soiling/incontinence,recurrent enterocolitis,anastomotic stenosis and anastomotic fistula.Soave procedure(60/151,39.7％)was a major reoperative approach,followed by heart-shaped anastomosis and Rehbein procedure.During a follow-up period of(6-60)months,4 cases lost follow-up.Among the remainders,there were death(n=4)and symptomatic improvements(n=143).In two groups,the major pathological types of ≤3-month group were common and long segment type.There was significant difference from that in＞3-month group(50.00％vs 6.29％,P＜0.001).The most common cause of reoperation was recurrent constipation in age＞3-month group and the difference was statistically significant as compared with ≤3-month group(37.50％vs 71.76％,P=0.041).The overall prognosis of ≤3-month group was worse than that of＞3-month group(improvement rate 62.50％vs 88.32％,P=0.035).No significant inter-group differences existed in other parameters(all P＞0.05).Conclusions A major cause for reoperation after HSCR operation is recurrent constipation.Selecting reoperative approaches is dependent upon a comprehensive assessment of initial operative approach,causes of reoperation and operator proficiency.Both short-term and long-term outcomes are satisfactory.
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