Why Do the Patients with Hirschsprung Disease Get Redo Pull-Through Operation?

Han, Ji Won; Youn, Joong Kee; Oh, Chaeyoun; Kim, Sujeong; Jung, Sung Eun; Park, Kwi Won

doi:10.1055/s-0038-1667038

Cited by 10 publications

(11 citation statements)

References 23 publications

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“…The two groups of patients were sometimes difficult to differentiate, meanwhile their treatments are quite different ( 12 ). When anastomotic leakage occurs, it usually needs staged reoperation ( 13 ), while inflammatory diseases usually need conservative therapy ( 14 ). Therefore, timely and accurate diagnosis is of great significance for determining strategies of treatment for postoperative hematochezia with various etiologies.…”

Section: Discussionmentioning

confidence: 99%

Colonoscopic Diagnosis of Postoperative Gastrointestinal Bleeding in Patients With Hirschsprung's Disease

Yang

Zhu

et al. 2021

Front. Pediatr.

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Aim: Postoperative lower gastrointestinal bleeding in children with Hirschsprung's Disease (HSCR) is a non-specific symptom, which may be caused by various etiologies. Our current study aims to utilize colonoscopy to diagnose the causes of postoperative hematochezia and to analyze its feasibility, accuracy, and safety.Methods: Twenty-four patients with HSCR with postoperative lower gastrointestinal bleeding or occult blood in the stool were enrolled in this study. The postoperative onset duration, age at examination, accompanied anomalies were recorded. After bowel preparation, all patients underwent colonoscopy. According to visual findings, mucosal biopsy was performed, followed by pathological diagnosis. Further treatment was determined according to the visual findings and pathological diagnosis. All patients were followed up for 6 months including therapeutic outcomes and recurrence of symptoms.Results: The mean onset duration was (221.3 ± 216.8) days postoperatively (ranging from 25 to 768 days). The mean age at examination was (41.0 ± 29.4) months. There was no significant difference in the onset days among each group (all, p > 0.05). Based on visual and pathological findings, there were 11 cases of HSCR associated enterocolitis (HAEC), 4 cases of anastomotic leakage, 7 cases of anastomotic inflammation, 1 case of juvenile polyp, and 1 case of inflammatory pseudopolyp. Intraluminal saline irrigation, thrombin treatment or colorectal polyp electrocision was performed according to intraoperative diagnosis. Patients with HEAC and anastomotic inflammation underwent antibiotics therapy and colorectal irrigation. Patients with leakage underwent reoperation. The highest incidence of accompanied symptoms of diarrhea existed in HEAC group (p = 0.02) and fever in leakage group (p = 0.02), respectively. No perforation or aggravated bleeding occurs in any patients. All patients gained uneventful recovery during follow-up period.Conclusions: Colonoscopy is a safe, accurate and timely examination for HSCR patients with postoperative lower gastrointestinal bleeding. The visual findings and biopsy may provide accurate diagnosis and guide treatment for this subset of patients.

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Section: Discussionmentioning

confidence: 99%

Colonoscopic Diagnosis of Postoperative Gastrointestinal Bleeding in Patients With Hirschsprung's Disease

Yang

Zhu

et al. 2021

Front. Pediatr.

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“…During prenatal embryonic development, cells from the neural crest migrate rostro-caudally inside the gut to form the myenteric and submucosal plexuses. In Hirschsprung disease (HD) neurons are missing from the distal parts of the intestine, leading to pathological aganglionic and hypoganglionic zones (Hirschsprung 1888; Han et al, 2018). The unpredictable length of the impaired intestine is a troublesome issue that sometimes prevents surgeons to fully remove the pathological segment and restore intestinal motility (Miele et al, 2000;Genser et al, 2013).…”

Section: Living Beings From Outsidementioning

confidence: 99%

To Know Them, Remove Them: An Outer Methodological Approach to Biophysics and Humanities

Tozzi¹

2021

Preprint

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Set theory faces two difficulties: formal definitions of sets/subsets are incapable of assessing biophysical issues; formal axiomatic systems are complete/inconsistent or incomplete/consistent. To overtake these problems reminiscent of the old-fashioned principle of individuation, we provide formal treatment/validation/operationalization of a methodological weapon termed “outer approach” (OA). The observer’s attention shifts from the system under evaluation to its surroundings, so that objects are investigated from outside. Subsets become just “holes” devoid of information inside larger sets. Sets are no longer passive containers, rather active structures enabling their content’s examination. Consequences/applications of OA include: a) operationalization of paraconsistent logics, anticipated by unexpected forerunners, in terms of advanced truth theories of natural language, anthropic principle and quantum dynamics; b) assessment of embryonic craniocaudal migration in terms of Turing’s spots; c) evaluation of hominids’ social behaviors in terms of evolutionary modifications of facial expression’s musculature; d) treatment of cortical action potentials in terms of collective movements of extracellular currents, leaving apart what happens inside the neurons; e) a critique of Shannon’s information in terms of the Arabic thinkers’ active/potential intellects. Also, OA provides an outer view of a) humanistic issues such as the enigmatic Celestino of Verona’s letter, Dante Alighieri’s “Hell” and the puzzling Voynich manuscript; b) historical issues such as Aldo Moro’s death and the Liston/Clay boxing fight. Summarizing, the safest methodology to quantify phenomena is to remove them from our observation and tackle an outer view, since mathematical/logical issues such as selective information deletion and set complement rescue incompleteness/inconsistency of biophysical systems.

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“…Severe bowel distension negatively affects bowel motility, thereby aggravating faecal stasis and increasing the risk of developing Hirschsprung-associated enterocolitis (HAEC), which can be life-threatening [4,5]. In these patients with persistent obstructive symptoms and permanently dilated bowel, redo surgery may be indicated [6]. Most often a redo pull-through is performed in order to surgically remove the distended non-motile bowel and restore faecal passage.…”

Section: Introductionmentioning

confidence: 99%

Redo surgery with longitudinal resection for dilated bowel in Hirschsprung disease: an illustrative case series

Roorda

Surridge

Visschers

et al. 2019

Int J Colorectal Dis

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Purpose Patients with Hirschsprung disease (HD) can have persistent obstructive symptoms after resection of the aganglionic segment. If obstructive symptoms are treated inadequately, this may lead to recurrent faecal stasis and impaction, and may result in severe distension of the bowel. A permanently distended bowel which not responds to conservative treatment may be an indication for redo surgery. The aim of this study is to describe our experiences and the short-term results of a novel technique: longitudinal antimesenteric resection with a longitudinal anastomosis. Methods We reviewed the medical records of our three patients who underwent longitudinal resection of severe distended bowel. This technique aims to improve defecation by improving faecal passage and is characterized by resection of the antimesenteric side of the distended intestinal segment, followed by plication with a longitudinal anastomosis. In this paper, this novel technique is described in detail, as well as short-term outcomes. Results All patients had an uneventful recovery after longitudinal antimesenteric resection. During follow-up, the functional outcomes were excellent, with a large improvement of bowel function. All patients were continent for faeces, and treated with low-dose laxatives or occasional preventive irrigation in one patient. There were no more complaints of persistent constipation or soiling. Conclusion Longitudinal resection is a surgical redo-procedure offering large benefits for patients with Hirschsprung disease with distended bowel after primary surgery.

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Why Do the Patients with Hirschsprung Disease Get Redo Pull-Through Operation?

Cited by 10 publications

References 23 publications

Colonoscopic Diagnosis of Postoperative Gastrointestinal Bleeding in Patients With Hirschsprung's Disease

Colonoscopic Diagnosis of Postoperative Gastrointestinal Bleeding in Patients With Hirschsprung's Disease

To Know Them, Remove Them: An Outer Methodological Approach to Biophysics and Humanities

Redo surgery with longitudinal resection for dilated bowel in Hirschsprung disease: an illustrative case series

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