Posterior myotomy/myectomy for persistent stooling problems in Hirschsprung's disease.

Details

Serval ID
serval:BIB_8C3C8461094B
Type
Article: article from journal or magazin.
Collection
Publications
Title
Posterior myotomy/myectomy for persistent stooling problems in Hirschsprung's disease.
Journal
Journal of Pediatric Surgery
Author(s)
Wildhaber B.E., Pakarinen M., Rintala R.J., Coran A.G., Teitelbaum D.H.
ISSN
1531-5037 (Electronic)
ISSN-L
0022-3468
Publication state
Published
Issued date
2004
Peer-reviewed
Oui
Volume
39
Number
6
Pages
920-6; discussion 920-6
Language
english
Notes
Publication types: Journal Article ; Review Publication Status: ppublish
Abstract
BACKGROUND: Hirschsprung's disease (HD) patients after pull-through (PT) may have recalcitrant constipation or recurrent enterocolitis (EC). Posterior myotomy/myectomy (POMM) are possible options for these problems. This study analyzed the outcome of POMM in HD patients post-PT.
METHODS: Records of 348 HD patients were reviewed, and 32 were found to have undergone a POMM post-PT (1981 to 2002). Outcomes after this procedure were assessed. Statistics used linear and logistic regression.
RESULTS: Of the 32 patients, 29 had complete records for analysis. Of those with pure constipation (12), 6 had aganglionosis post-PT. Of those with recurrent EC (17) only 1 had aganglionosis post-PT. POMM was performed at a mean of 3.1 years post-PT (11 myotomy, 18 myectomy). Average follow-up was 8.6 years (range, 0.7 to 21). Type of POMM had no correlation with overall functional outcome (P =.44). Of those with chronic constipation, 60% had good results after POMM; the remainder required a redo-PT or colostomy. Interestingly, most patients with retained aganglionosis and chronic constipation did not respond after POMM (83%). Of those with recurrent EC, 75% became free of symptoms; none of the patients not responding have required redo-PT.
CONCLUSIONS: POMM to treat chronic constipation or recurrent EC in patients with HD post-PT is moderately successful. Because of the unsuccessful outcome with POMM in patients with a combination of constipation and aganglionosis, one should defer to a redo-PT in this group.
Keywords
Anal Canal/surgery, Anastomosis, Surgical, Botulinum Toxins, Type A/therapeutic use, Child, Child, Preschool, Colostomy, Constipation/drug therapy, Constipation/etiology, Defecation, Encopresis/drug therapy, Encopresis/etiology, Enterocolitis/etiology, Female, Hirschsprung Disease/complications, Hirschsprung Disease/surgery, Humans, Male, Postoperative Complications/etiology, Postoperative Complications/surgery, Recurrence, Retrospective Studies, Surgical Flaps
Pubmed
Web of science
Create date
21/02/2015 13:04
Last modification date
20/08/2019 14:50
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