Redo Pull-through in Hirschsprungs Disease - A Meta-Analysis of Outcomes Based on type of Pull-through.

Abstract

Purpose: The meta-analysis investigates the effects of redo pull-through (PT) surgeries on bowel function outcomes in patients with rectosigmoid and long-segment Hirschsprung's disease (HD) who have already undergone an initial PT. By comparing different redo PT techniques, this study explores whether specific approaches yield better postoperative bowel function.

Methodology: A literature search was conducted for articles on redo PT for HD; this included PubMed and ScienceDirect databases. The search terms or MeSH words "Hirschsprung disease" OR "congenital megacolon" AND "re-do pull through" OR "re-do" OR "reoperation," connected by two Boolean operators "OR" and "AND," were used to search the databases for relevant articles.

Results: Fifteen articles of interest comprising 374 patients receiving redo PT were selected for analysis. The results suggest that selecting a redo PT method tailored to the patient's unique anatomical and surgical history may substantially improve functional outcomes, highlighting the potential for individualized strategies to enhance recovery and long-term quality of life for those requiring reoperation.

Conclusion: The findings indicate that the Swenson redo PT approach yielded better bowel function outcomes compared to other techniques. While redo PT procedures were effective in reducing fecal incontinence, the incidence of enterocolitis remained consistent across the various approaches.