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

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.

• Authors: Barbara E Wildhaber, Mikko Pakarinen, Risto J Rintala, Arnold G Coran, Daniel H Teitelbaum
• Journal: Journal of pediatric surgery (J Pediatr Surg) Vol. 39 Issue 6 Pg. 920-6; discussion 920-6 (Jun 2004) ISSN: 1531-5037 [Electronic] United States
• PMID: 15185226 (Publication Type: Journal Article, Review)

Chemical References

• Botulinum Toxins, Type A

Topics

• Anal Canal (surgery)
• Anastomosis, Surgical
• Botulinum Toxins, Type A (therapeutic use)
• Child
• Child, Preschool
• Colostomy
• Constipation (drug therapy, etiology, surgery)
• Defecation
• Encopresis (drug therapy, etiology, surgery)
• Enterocolitis (etiology)
• Female
• Hirschsprung Disease (complications, surgery)
• Humans
• Male
• Postoperative Complications (etiology, surgery)
• Recurrence
• Retrospective Studies
• Surgical Flaps