Complications
Incidence of postoperative anastomotic leak is reported to be up to 3.4%.[99] Treatment may require antibiotics, drainage, and/or intestinal diversion.
Incidence of postoperative anastomotic stricture is reported to occur in up to 14.6% of patients.[99] Treatment may require dilation, corticosteroid-injections, and/or re-do surgery.
A small number of patients with Hirschsprung's disease also develop IBD. Long-segment disease and Down syndrome are risk factors for Hirschsprung-associated IBD.[101]
HAEC is reported in 20% to 60% of patients and can occur both pre- and postoperatively.[12] Early diagnosis and treatment are key.[11] Irrigations and treatment with hydration and metronidazole are the mainstays of therapy.[11] Intra-sphincteric botulinum toxin injections have been shown to reduce the incidence of recurrent enterocolitis.[11][27] On occasion, retention of aganglionic bowel or a dilated segment of colon due to an inadequate pull-through is the cause, and further surgical intervention is required.[11][35]
Stoma-related complications include prolapse, stricture, and retraction and are reported in about 21% of patients with Hirschsprung's disease and an enterostomy. Patients with long-segment Hirschsprung's disease are more likely to experience stoma-related complications, likely due to the longer duration of the stoma.[100]
Obstructive symptoms (e.g., constipation or obstipation) after pull-through surgery is common, reported in up to 40% of patients.[88][89][99] Obstructive symptoms may be due to a myriad of factors including but not limited to: internal sphincter achalasia, anastomotic stricture, twisted pull-through, obstructive Yancey-Soave cuff, Duhamel spur, and transition zone pull-through.[89]
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