Abstract
Background
Anastomotic leakage (AL) is one of the most perplexing complications that can occur following a radical operation to treat Hirschsprung disease (HSCR). The purpose of this study was to document our experience with anastomotic leakage following radical HSCR surgery to enhance therapeutic effect and prognosis.
Methods
Between January 2007 and April 2021, a retrospective study was conducted on 12 children who developed anastomotic leakage following radical surgery for HSCR. Medical records were analyzed to determine the clinical manifestations, primary surgical procedures, evaluation methods, surgical plans, and outcomes of the patients. To assess postoperative bowel function, the Rintala score was used.
Results
The Soave procedure was used as the primary surgical method in seven cases (58.3%), the Swenson procedure was used in four cases (33.3%), and the Rehbein procedure was used in one case (8.3%). Enterostomy (10, 83.3%) and conservative treatment (2, 16.7%) were performed when anastomotic leakage was diagnosed. Two patients who directly closed stoma without redoing pull-through both accepted enterostomy within 48 h. One female with anastomotic fistula who was closed leakage or fistula in situ had to endure lifelong stoma. Other patients who underwent redo pull-through procedures had normal bowel function. Seven patients underwent a redo pull-through procedure. Three of them preferred the transanal full-thickness pull-through (FTPT) approach, while four preferred the Soave technique. Three children had mild postoperative soiling, which improved with conservative treatment. Bowel function score was 17.5 ± 1.1.
Conclusion
Enterostomy should be performed immediately if anastomotic leakage occurs. After leakage, it is necessary to redo the pull-through procedure in an anastomotic fistula or anastomotic stricture. Transanal FTPT reconstruction is an effective method for repairing anastomoses and leakage.
Similar content being viewed by others
References
Das K, Mohanty S (2017) Hirschsprung disease—current diagnosis and management. Indian J Pediatr 84:618–623. https://doi.org/10.1007/s12098-017-2371-8
Tam PKH (2016) Hirschsprung’s disease: a bridge for science and surgery. J Pediatr Surg 51:18–22. https://doi.org/10.1016/j.jpedsurg.2015.10.021
Wang Y-J, Han Z-C, Chen L et al (2022) Clinical efficacy of an indwelling transanal tube for the prevention of anastomotic leakage after hirschsprung’s disease: a single center experience with Chinese patients. J Laparoendosc Adv Surg Tech 32:342–346. https://doi.org/10.1089/lap.2021.0644
Pratap A, Gupta DK, Shakya VC et al (2007) Analysis of problems, complications, avoidance and management with transanal pull-through for Hirschsprung disease. J Pediatr Surg 42:1869–1876. https://doi.org/10.1016/j.jpedsurg.2007.07.017
Peng C, Tan SS, Pang W et al (2021) Rectourethral and rectovesical fistula as serious and rare complications after Hirschsprung disease operation: experience in seven patients. J Pediatr Surg 56:263–268. https://doi.org/10.1016/j.jpedsurg.2020.06.042
Peng CH, Chen YJ, Pang WB et al (2018) STROBE-anastomotic leakage after pull-through procedure for Hirschsprung disease. Medicine (United States) 97:e13140. https://doi.org/10.1097/MD.0000000000013140
Chi S, Guo J, Zhang X et al (2020) Resuturing without enterostomy for the treatment of early-stage anastomotic leaks after laparoscopic Soave procedure in Hirschsprung’s disease. J Laparoendosc Adv Surg Tech 30:1295–1300. https://doi.org/10.1089/lap.2020.0640
Rintala RJ, Lindahl H (1995) Is normal bowel function possible after repair of intermediate and high anorectal malformations? J Pediatr Surg 30:491–494. https://doi.org/10.1016/0022-3468(95)90064-0
Prato AP, Arnoldi R, Faticato MG et al (2020) Minimally invasive Redo pull-throughs in Hirschsprung disease. J Laparoendosc Adv Surg Tech 30:1023–1028. https://doi.org/10.1089/lap.2020.0250
Van Leeuwen K, Teitelbaum DH, Elhalaby EA, Coran AG (2000) Long-term follow-up of redo pull-through procedures for Hirschsprung’s disease: efficacy of the endorectal pull-through. J Pediatr Surg 35:829–834. https://doi.org/10.1053/jpsu.2000.6853
Liem NT, Hau BD, Son HT (2005) Modified Soave procedure through the posterior sagittal approach for Hirschsprung’s disease. J Pediatr Surg 40:547–550. https://doi.org/10.1016/j.jpedsurg.2004.11.044
Sun S, Chen G, Zheng S et al (2017) Usefulness of posterior sagittal anorectoplasty for redo pull-through in complicated and recurrent Hirschsprung disease: experience with a single surgical group. J Pediatr Surg 52:458–462. https://doi.org/10.1016/j.jpedsurg.2016.08.016
Lefèvre JH, Parc Y (2011) Soave procedure. J Visc Surg 148:262–266. https://doi.org/10.1016/j.jviscsurg.2011.07.006
Delgado-Miguel C, Camps JI (2022) Robotic Soave pull-through procedure for Hirschsprung’s disease in children under 12-months: long-term outcomes. Pediatr Surg Int 38:51–57. https://doi.org/10.1007/s00383-021-05018-6
Newland JJ, Dukleska K, Cowan S et al (2019) Dr. Orvar Swenson and the Pull-through. Am Surg 85:1311–1313. https://doi.org/10.1177/000313481908501221
Levitt MA, Hamrick MC, Eradi B et al (2013) Transanal, full-thickness, Swenson-like approach for Hirschsprung disease. J Pediatr Surg 48:2289–2295. https://doi.org/10.1016/j.jpedsurg.2013.03.002
Duncan ND, Plummer J, Dundas SE et al (2011) Adult Hirschsprung’s disease in Jamaica: operative treatment and outcome. Colorectal Dis 13:454–458. https://doi.org/10.1111/j.1463-1318.2009.02174.x
Stensrud KJ, Emblem R, Bjornland K (2012) Late diagnosis of Hirschsprung disease—Patient characteristics and results. J Pediatr Surg 47:1874–1879. https://doi.org/10.1016/j.jpedsurg.2012.04.022
Moore SW (2009) Total colonic aganglionosis and Hirschsprung’s disease: shades of the same or different? Pediatr Surg Int 25:659–666. https://doi.org/10.1007/s00383-009-2408-9
Wildhaber BE, Teitelbaum DH, Coran AG (2005) Total colonic Hirschsprung’s disease: a 28-year experience. J Pediatr Surg 40:203–207. https://doi.org/10.1016/j.jpedsurg.2004.09.033
Jarvi K, Laitakari EM, Koivusalo A et al (2010) Bowel function and gastrointestinal quality of life among adults operated for Hirschsprung disease during childhood: a population-based study. Ann Surg 252:977–981. https://doi.org/10.1097/SLA.0b013e3182018542
Author information
Authors and Affiliations
Corresponding author
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Jiao, C., Zhuansun, D., He, Y. et al. Transanal full-thickness pull-through approach in the treatment of anastomotic leakage after operation for Hirschsprung disease. Pediatr Surg Int 38, 1263–1271 (2022). https://doi.org/10.1007/s00383-022-05164-5
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00383-022-05164-5