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Transition zone pull‐through in Hirschsprung's disease: a tertiary hospital experience
Author(s) -
Ghosh Dhruva N.,
Liu Yingrui,
Cass Daniel T.,
Soundappan Soundappan S. V.
Publication year - 2017
Publication title -
anz journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.426
H-Index - 70
eISSN - 1445-2197
pISSN - 1445-1433
DOI - 10.1111/ans.13745
Subject(s) - medicine , hirschsprung's disease , surgery , constipation , bowel obstruction , incidence (geometry) , transition zone , enterocolitis , disease , gastroenterology , optics , geology , physics , geochemistry
Background Pull‐through of ganglionic bowel is essential for successful treatment of Hirschsprung's disease. We studied the incidence of transition zone pull‐through in our institution and compared its outcome with ganglionic bowel pull‐through. Methods Children who underwent Soave's pull‐through for Hirschsprung's disease from January 2005 to November 2012 were studied. Patients were divided into two groups: ganglionic bowel pull‐throughs (Group 1) and transition zone pull‐throughs (Group 2). Demographics, presentations, surgical procedure, post‐operative results and complications including redo procedures were recorded and reviewed along with histopathology reports. Results Fifty patients underwent Soave's pull‐through for Hirschsprung's disease in our group. The median age at surgery was 13.5 days in Group 1 and 22.5 days in Group 2. Transition zone pull‐through occurred in eight children (16%). Transition zone pull‐through was attributed to errors in histologic interpretation ( n = 5), sampling ( n = 2) and surgical technique ( n = 1). The transition zone was significantly longer in Group 2 ( P = 0.002). Constipation and enterocolitis were the main complications needing therapy. One child in Group 2 required surgery for adhesive intestinal obstruction. Conclusions The length of the transition zone in children with transition zone pull‐through was significantly longer. Though our children with transition zone pull‐through did not require redo surgery the possibility of redo surgery remains. Transition zone pull‐through should still be considered an error and should be prevented.