PMID- 32716243 OWN - NLM STAT- MEDLINE DCOM- 20210210 LR - 20210210 IS - 1557-9034 (Electronic) IS - 1092-6429 (Linking) VI - 30 IP - 9 DP - 2020 Sep TI - Minimally Invasive Redo Pull-Throughs in Hirschsprung Disease. PG - 1023-1028 LID - 10.1089/lap.2020.0250 [doi] AB - Introduction: To reoperate a patient with Hirschsprung disease (HSCR) can be technically demanding and most surgeons would resort to conventional laparotomy. This article describes a series of patients with postoperative obstructive symptoms who underwent minimally invasive redo pull-throughs (MIRPT) (either laparoscopic or robotic) to assess the role of minimally invasive surgery (MIS) in complicated HSCR patients. Patients and Methods: All consecutive HSCR patients with postoperative obstructive symptoms, who underwent MIRPT with fast track concepts of care between January 2012 and January 2020, have been included. Data regarding indications, surgical details, complications, and outcome have been compared to those of a series of patients who underwent conventional laparotomic redo. Results: Sixteen patients were included. Male to female ratio was 4.3:1. Median age at surgery was 78 months. Eleven patients underwent laparoscopic redo and 5 underwent robotic redo. Median length of follow-up was 49 months. Reasons for redoing were transition zone pull-through, residual aganglionosis, anastomotic retraction or leak, rectal diverticulum, and refractory anastomotic stricture. No major intraoperative complication occurred. No conversion to laparotomy was required. One patient experienced cuff stricture requiring laparoscopic release. Two patients reported bouts of enterocolitis postoperatively. Compared to classic laparotomic redo pull-throughs (49 patients with complete data), overall complications were significantly less frequent, accounting for 1 and 21 events, respectively (6% versus 43%) (P = .0067). Continence after a median of 21 months postoperatively scored excellent to good in 9 out of 12 patients, who were assessed on this regard (75%), without statistically significant differences. Conclusions: MIRPT proved to be effective and safe in HSCR patients complaining postoperative obstructive symptoms. Robotic surgery could play a crucial. Our study confirms that complicated HSCR cases can be safely managed by means of MIS, applying concepts of fast track care to serve the best for our patients. FAU - Pini Prato, Alessio AU - Pini Prato A AD - Pediatric Surgery Unit, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy. AD - Umberto Bosio Center for Digestive Diseases, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy. AD - The Children Hospital, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy. FAU - Arnoldi, Rossella AU - Arnoldi R AD - Pediatric Surgery Unit, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy. AD - Umberto Bosio Center for Digestive Diseases, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy. AD - The Children Hospital, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy. FAU - Faticato, Maria Grazia AU - Faticato MG AD - Pediatric Surgery Unit, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy. AD - Umberto Bosio Center for Digestive Diseases, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy. AD - The Children Hospital, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy. FAU - Mariani, Narciso AU - Mariani N AD - Umberto Bosio Center for Digestive Diseases, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy. AD - Pathology Unit, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy. FAU - Dusio, Maria Pia AU - Dusio MP AD - Umberto Bosio Center for Digestive Diseases, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy. AD - The Children Hospital, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy. AD - Intensive Care Unit, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy. FAU - Felici, Enrico AU - Felici E AD - Umberto Bosio Center for Digestive Diseases, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy. AD - The Children Hospital, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy. AD - Pediatrics Unit, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy. FAU - Tentori, Augusta AU - Tentori A AD - Umberto Bosio Center for Digestive Diseases, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy. AD - The Children Hospital, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy. AD - Radiology Unit, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy. FAU - Nozza, Paolo AU - Nozza P AD - Umberto Bosio Center for Digestive Diseases, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy. AD - Pathology Unit, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy. LA - eng PT - Journal Article DEP - 20200721 PL - United States TA - J Laparoendosc Adv Surg Tech A JT - Journal of laparoendoscopic & advanced surgical techniques. Part A JID - 9706293 SB - IM MH - Adolescent MH - Child MH - Child, Preschool MH - Digestive System Surgical Procedures/adverse effects/methods MH - Enterocolitis/etiology MH - Female MH - Hirschsprung Disease/*surgery MH - Humans MH - Infant MH - *Laparoscopy MH - Laparotomy/adverse effects MH - Male MH - Postoperative Complications/etiology/*surgery MH - Postoperative Period MH - Reoperation/methods MH - *Robotic Surgical Procedures MH - Treatment Outcome OTO - NOTNLM OT - Hirschsprung OT - laparoscopy OT - postoperative obstructive symptoms OT - redo pull-through OT - robotic surgery EDAT- 2020/07/28 06:00 MHDA- 2021/02/11 06:00 CRDT- 2020/07/28 06:00 PHST- 2020/07/28 06:00 [pubmed] PHST- 2021/02/11 06:00 [medline] PHST- 2020/07/28 06:00 [entrez] AID - 10.1089/lap.2020.0250 [doi] PST - ppublish SO - J Laparoendosc Adv Surg Tech A. 2020 Sep;30(9):1023-1028. doi: 10.1089/lap.2020.0250. Epub 2020 Jul 21.