Should we perform a Hirschsprung redo pull-through on patients with retained transition zone?

Abstract

Background: In Patients with Hirschsprung Disease (HSCR) suffering from obstructive symptoms after their pull-through surgery, a transition zone pull-through (TZPT) was suggested as a causing factor. Current guidelines recommend a reoperation resecting the transition zone in these patients. This present study reports the clinical outcomes in patients with a confirmed TZPT. Methods: A retrospective review of patients who underwent a primary transanal pull-through for recto-sigmoid HSCR at the Children's Hospital Colorado from January 2010 until June 2020 was performed. We included patients with a TZPT confirmed on the definitive histopathological report of the proximal margin's circumference obtained at the time of their pull-through surgery and follow-up at the Children's Hospital Colorado. Demographic data were collected. The primary outcome of interest was fecal control, episodes of Hirschsprung-associated enterocolitis (HAEC), the necessity of bowel management (with either laxatives or enemas), and a redo pull-through. Results: Six patients had a TZPT. Two patients suffered episodes of HAEC. One patient is fecal incontinent. None of them underwent redo pull-through surgery. Medical treatment was successful in all with obstructive symptoms. Conclusion: Patients who underwent a pull-through surgery for HSCR with retained transition zone may suffer from obstructive symptoms, which can be managed conservatively with medical treatment. A TZPT is not necessarily associated with persistent obstructive symptoms. Level of evidence/type of study: Level III, retrospective.

Keywords

• Hirschsprung disease
• Transition zone
• Pull-through
• Hirschsprung-associated enterocolitis
• Obstructive symptoms
• Constipation