Redo Pull-Through and Secondary Operation
Complications after pull-through will greatly affect the quality of life of children with Hirschsprung disease. If conservative management is unsuccessful for complications, surgical therapy should be considered. Postoperative complications mainly consist of anatomical and pathological problems. It is natural that successful treatment cannot be achieved unless the cause of any complication is apparent. If conservative management is unsuccessful, a secondary or redo pull-through operation should be considered. Secondary or redo pull-through surgery might be necessary because of obstructive symptoms and true incontinence. However, there is no best approach for redo pull-through for obstructive symptoms nor secondary surgery for true incontinence, and all of these procedures for the treatment of Hirschsprung disease are technically challenging. Postoperative true fecal incontinence is a more serious problem that can significantly diminish the quality of life of children, more so than obstructive symptoms. Anal canal plasty might be effective for the treatment of true incontinence with a patulous anus. Most of the postoperative complications are preventable by careful pathological judgment and appropriate surgical procedure. The surgeon must understand the cause of each complication and undertake the initial surgery to reduce such complications.
KeywordsHirschsprung disease Complications Redo pull-through operation Secondary operation Obstructive symptoms Fecal incontinence
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