Redo Pull-through: Patient Characteristics, Indications & Outcome at Tikur Anbessa Hospital, Ethiopia, 2010-2019
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Date
2021-11
Authors
Journal Title
Journal ISSN
Volume Title
Publisher
Addis Abeba University
Abstract
Background: HSD is a developmental disorder of the intrinsic nervious system of the distal colon. The
management is pull through procedure and majority of patients do well after surgery; but 32% of patients
continue to have complaints after surgery & up to 8.6% of patients can require repeat pull through.
Objective: To describe indications for reoperation, surgical technique adopted, complications, and
outcome of patients who underwent a redo pull-through procedure in Tikur Anbessa hospital, Ethiopia
from
Methodology: Retrospective descriptive study design was used and the sampling procedure was a multistage
sampling.
Descriptive
statistics
(mean,
SD,
frequency,
percentage,
graph
and
table)
was
generated
by
using
SPSS
version
21.
Results: In our study a total of 18(4.87% of all PT) patients underwent redo pull through from 2010-
2019. 13 (72.2%) were males & 5 (27.8%) were females with male to female ratio of 2.6:1. Soave pull
through was the most frequent type of pull through on first time; done on 16(94.2%) of patients, two
being primary TERPT, and Duhamel pull through for one(5.9%) patient. The type of initial PT wasn’t
known in one. The indication for redo PT was pathologically confirmed persistent/aquired aganglionosis
in 8(50%) patients. 5(27.8%) patients had anastomotic site stricture confirmed with examination under
anesthesia. Three of them were done for persistent obstructive features with clinical impression of
aganglionosis. Twisted colon & anastomotic failure with colonic retraction accounted for one patient
each. Swenson procedure was performed on 15 (83.3%)patients & Soave pull through was done on
3(16.7%) patients as the procedure for the redo PT. Long term outcome of patients after redo pull through
was measured using Holschneider’s FII score. Of the patients FII score was obtained (11 of them), 6
patients achieved good continence,3 has fair continence sttus & one patient was incontinent & required
bowel management program to stay clean. One patient was less than 4 years old & not toilet trained yet.
In 7 patients the Hilschneider FII score couldn’t be obtained.
Conclusion : The indication for redo pull through was persistent obstructive features in 77.8% of
patients. The causes of persistent obstructive symptoms after an initial pull-through procedure are pull
through of aganglionated segment (50%) and anastomotic site stricture (27.8%). 81.8% of those for whom
the Holschneider FII score was obtained has fair t good continence.
Description
Keywords
Patients, Reoperation,Surgical technique