Sun Song,Zheng Shan,Chen Gong,et al.Reoperation after radical surgery for Hirschsprung’s disease: analysis of causes and risk factors[J].Journal of Clinical Pediatric Surgery,,():424-429.[doi:10.3760/cma.j.cn101785-20260302-00082]
Reoperation after radical surgery for Hirschsprung’s disease: analysis of causes and risk factors
- Keywords:
- Hirschsprung Disease; Reoperation; Root Cause Analysis; Child
- Abstract:
- Objective Tosystematically explore the causes of reoperation after radical surgery for Hirschsprung’s disease (HSCR) and examine the associated risk factors and protective factors.Methods From January 2018 to December 2024,the relevant clinical data were retrospectively reviewed for 507 operated HSCR children.According to whether or not reoperation was required for complications after radical surgery,they were assigned into two groups of reoperation (n=108) and non-reoperation (n=399).Descriptive analysis was performed for the causes of reoperation.Univariate and multivariate Logistic regression analyses were employed for identifying independent influencing factors for reoperation.Results The three major causes of reoperation after radical HSCR surgery were anastomotic leakage (n=33,30.6%),residual aganglionic segment (n=16,14.8%) and colonic dilation with normal ganglion cells (n=15,13.9%).Univariate analysis revealed that reoperation group had significantly higher proportions of associated malformations,long-segment and total colonic aganglionosis,protective enterostomy and longer postoperative hospital stay as compared with non-reoperation group (P<0.05).However,the proportions of initial surgery performed at tertiary hospitals,concurrent transabdominal approach and primary caregivers with higher education background were significantly lower in reoperation group (P<0.05).Multivariate Logistic regression analysis indicated that long-segment aganglionosis (OR=3.302,95%CI:1.718-6.320) was an independent risk factor for reoperation (P=0.001).Conversely,initial radical surgery performed at tertiary hospitals (OR=0.601,95%CI:0.398-0.900),concurrent transabdominal approach (OR=0.704,95%CI:0.488-0.903) and primary caregivers with higher education background (OR=0.598,95%CI:0.363-0.994) were independent protective factors (P<0.05).Conclusion Anastomotic leakage,residual aganglionic segment and colonic dilation are three major causes of reoperation after HSCR surgery.For high-risk individuals with long-segment aganglionosis,it is imperative to seek treatment at experienced medical centers,adopt a concurrent transabdominal surgical approach and emphasize family-centered long-term postoperative management and education to lower the reoperation rate and improve long-term outcomes.
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Memo
收稿日期:2026-3-2。
基金项目:复旦大学附属儿科医院临床队列项目巨结肠专病队列建设项目(LCDL-BZ-013);2024年厦门市卫生健康高质量发展科技计划医学创新课题资助计划(2024GZL-CX24)
通讯作者:沈淳,Email:chunshen0521@126.com