Advances in pediatric surgery
- 제10권1호
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- Pages.1-8
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- 2004
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- 2635-8778(pISSN)
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- 2635-8786(eISSN)
Hirschsprung 병에서의 재 교정 수술의 성적
Re-pull-through Operation in Hirschsprung's Disease
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김현영
(서울대학교 의과대학 외과학교실) ;
- 박귀원 (서울대학교 의과대학 외과학교실) ;
- 전용순 (인제대학교 의과대학 부산백병원 외과학교실) ;
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정성은
(서울대학교 의과대학 외과학교실) ;
- 이성철 (서울대학교 의과대학 외과학교실) ;
- 김우기 (서울대학교 의과대학 외과학교실)
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Kim, Hyun-Young
(Department of Surgery Seoul National University) ;
- Park, Kwi-Won (Department of Surgery Seoul National University) ;
- Chun, Yong-Soon (Department of Surgery, Inje University College of Medicine, Pusan Paik Hospital) ;
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Jung, Seung-Eun
(Department of Surgery Seoul National University) ;
- Lee, Seong-Cheol (Department of Surgery Seoul National University) ;
- Kim, Woo-Ki (Department of Surgery Seoul National University)
- 발행 : 2004.06.30
초록
A re-pull-through operation for Hirschsprung's disease is performed when the primary operation has failed because of the remnant or acquired aganglionosis, anastomotic stricture and/or fistula. The purpose of this study is to review our experience of the re-pull-through procedure for Hirschsprung's disease. From May 1978 to July 2003, 26 patients who underwent re-pull-through operations at the Department of Pediatric Surgery, Seoul National University Children's Hospital, were studied retrospectively by means of chart review as well as telephone interview. The mean age at primary operation and re-operation were llmonths (2 months - 10 years) and 43 months (1 year - 23 years 3 months), respectively. Initial operation for Hirschsprung's disease was Duhamel's procedure in 17, Swenson's in 6 and Soave's 3. Causes of failure of primary operation were remains of secondary aganglionic segment (n=23), vascular arcade injury (n= 1), rectoperineal fistula (n=2, due to mesenteric torsion and poor blood supply), Mean interval between the primary operation and the re-operation was 34 months (6 months-22 years). Reoperation methods were Soave's in 12, Duhamel's in 8, APSP (abdomino-posterosagittal pull-through procedure) in 5, and Swenson's in 1 case. In 2 cases of repeated rectoperineal fistula or rectourethral fistula, re-APSP were performed 3 times, respectively. A total of 29 re-pull-through operations were performed. Postoperative complications were wound infection (n=1), adhesive ileus (n=1), rectoperineal fistula (n=3), rectourethral fistula (n=2), and death due to pulmonary embolism (n=1). Mean follow up period of reoperation was 78 months (1 month-23years). In current state, 2 patients have an ileostomy because of repeated rectoperineal fistula and rectourethral fistula. Of the remaining 23 patients, 21(91 %) are totally continent with or without minimal soiling. Reoperation for Hirschsprung's disease was effective and safe for the patients complicated to the initial pull-through operation.