WOFAPS 2025 8th World Congress of Pediatric Surgery

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Oral Presentation - 48

Robotic-assisted redo pull-through procedures of Hirschsprung's disease for complications : a single team experience in China

Menglong Lan
Guangzhou Women and Children's Medical Center,Guangzhou Medical University

Objective To evaluate the safety and effectiveness of robotic-assisted redo pull-through procedure (RAPT) due to complications after primary pull-through procedure (PT) for Hirschsprung’s disease (HSCR), analyze the reasons for reoperation and summarize surgical experience.

Methods: The clinical data of 16 patients who underwent RARPT for complications after primary PT for HSCR from November 2022 to July 2024 in the Department of Gastrointestinal Surgery, Women and Children's Medical Center of Guangzhou Medical University were retrospectively analyzed. Among them, 10 were male and 6 were female. The reasons for reoperation were: recurrence of constipation in 7 cases (1 case of acquired aganglionosis, 2 cases of residual rectal muscle cuff, 4 cases of residual aganglionic segment or transitional zone), and 6 cases of anastomotic fistula (2 cases of rectovaginal fistula) and anastomotic stenosis (3 cases). Reoperation methods included RARPT (Deloyers + Swenson) in 7 cases, RARPT (Swenson) in 7 cases (including simultaneous residual muscle sheath resection in 2 cases, and removal of scar granulation tissue around the anastomotic fistula in 5 cases), 2 cases of RARPT (Swenson) and repair of rectovaginal fistula.

Results: The median operation time was 315 minutes (200-510 minutes), the bleeding volume was less than 20 ml, the postoperative recovery time for eating and drinking was 2-7 days, the first postoperative defecation time was 1-3 days, and the postoperative hospital stay was 8-14 days. There were no serious complications during the operation and no conversion to laparotomy. One patient developed incomplete intestinal obstruction while in the hospital and improved after conservative treatment and was discharged. Postoperative follow-up was from 2 to 21 months. Among them, 1 case had returned to the hospital for incomplete intestinal obstruction, 1 case developed enterocolitis, which improved after enema, and 6 cases of soiling.

Conclusion: RARPT is safe and effective for postoperative complictions of Hirschsprung's disease .

Keywords: Hirschsprung's disease, Postoperative complications, Reoperation, Robotic-assisted surgery, Child

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