Management of Recurrent Post Redo Pull-Through Stricture – What is the Option?

Khope, Sanjay; Dalal, Subash J.

doi:10.1007/s12262-012-0519-3

Cited by 1 publication

(4 citation statements)

References 9 publications

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“…Only one-third of LDHD had occasional (once or twice a week, grade I) fecal incontinence and none achieved full continence. This contrasted the Norwegian report of 27% incontinence rate in a cohort comparable in demographics and operative approaches (mainly Soave) as ours, except for significantly shorter follow-up in their group with a median age of 3 years (5 months-12 years) 6 compared with ours with a median age of 5.6 years (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19) in this study. This might be enough to make a difference but remains untested.…”

Section: Discussioncontrasting

confidence: 99%

“…Median gestation was 39.7 weeks (26.0-41.7) with a male predominance (40/49, 82%) and the majority had a Soave endorectal PT (36/49, 74%). Median age at the time of final follow-up was 8 years (5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20).…”

Section: Resultsmentioning

confidence: 99%

“…However, our permanent stoma rate was higher at 10% when compared with 2% in the national study. This could be, in part, due to a longer follow-up period in our cohort of patients which had a median age of 8 years (5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20), and even more prominently when considering the group of patients who had persistent stoma-with median follow-up going as far as 11 years of age (5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18). Furthermore, this difference was likely attributable to 22% of our cohort were over 6 months and 18% over 1 year of age at diagnosis, as compared with the NETS 2HD study which only included patients diagnosed with HD under 6 months of age.…”

Section: Discussionmentioning

confidence: 99%

“…Stricture after PT is relatively uncommon in HD 18,19 but we have evaluated this in our study because eight patients developed a stricture (16%), of which six required either a redo PT or ended with a permanent stoma (75%) (►Table 4). Strategies to prevent ischemia, tension, and infections are therefore key to preventing this devastating complication.…”

Section: Discussionmentioning

confidence: 99%

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Late Diagnosis of Hirschsprung's Disease: Definition and Implication on Core Outcomes

et al. 2022

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Introduction Late diagnosis of Hirschsprung's disease (LDHD) may carry a poor prognosis. Its definition remains unclear and its implication on HD-related core outcomes has not been fully reported. Methods A single-center 20-year series was reviewed to include HD with follow-up of 1 year or more post pull-through (PT) and aged 5 years or older. We investigated six core outcomes derived from NETS1HD study by comparing the groups dichotomized by four time points using age at diagnosis (44-week gestation, 6 months, 1 year, and 3 years). Following establishment of definition of LDHD, the outcomes and complications were compared with timely diagnosis of HD (TDHD). Results Forty-nine out of eighty-six HD were included. The definition of LDHD was found to be HD diagnosed at 1 year of age or later because 3/6 core outcomes were significantly worse than TDHD. Nine patients (18%) had LDHD—median age at diagnosis 42 months (12–89) and PT performed at 57 months (12–103), mostly Soave (73%); a covering stoma was performed in 7/9, significantly higher than TDHD in 10/40 (p = 0.001). LDHD was associated with increased unplanned surgery (78% vs. 30%, p = 0.019), fecal incontinence (100% vs. 62%, p = 0.01), and permanent stoma (33% vs. 5%, p = 0.037). Major complications (56% vs. 20%, p = 0.043) and redo PT (33% vs. 5%, p = 0.037) were also higher in LDHD. Conclusion LDHD could be defined as HD diagnosis at or over 1 year of age. LDHD was associated with more preoperative stoma, major postoperative complications, unplanned reoperation, and worse HD-related core outcomes.

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