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Comparative Study
. 2025 Apr 22;25(1):313.
doi: 10.1186/s12887-025-05680-y.

Analysis of the causes of redo pull-through for recurrent constipation and the risk factors affecting the prognosis of the Hirschsprung's disease: a single-center retrospective study and systematic review

Jun Xiao #  1   2 , Shimin Yang #  1   2 , Lei Xiang #  1   2 , Bo Qin #  1   3 , Jingyi You  1   2 , Mei Dong  4 , Youshan Xie  5 , Xuan Zhang  6 , Xuyong Chen  1   2 , Zejian Li  7   8 , Honglin Li  9   10 , Jiexiong Feng  11   12
Affiliations
Comparative Study

Analysis of the causes of redo pull-through for recurrent constipation and the risk factors affecting the prognosis of the Hirschsprung's disease: a single-center retrospective study and systematic review

Jun Xiao et al. BMC Pediatr. .

Abstract

Background: Hirschsprung's disease (HSCR) is a congenital gastrointestinal disorder. Pull-through (PT) surgery, the primary treatment, often leads to recurrent constipation. The causes of redo pull-through (redo-PT) for recurrent constipation remain unclear, with limited research on follow-up outcomes and prognostic factors.

Methods: We searched "PubMed" and "Web of Science" for references using the title/abstract terms "Hirschsprung" and "Redo pull-through". We enrolled patients from the literature review group and our retrospective group who underwent redo-PT for recurrent constipation. A comparative analysis was conducted between two groups based on the clinical information for redo-PT.

Results: A total of 360 cases were collected from the references (327 patients) and our center (33 patients). Recurrent aganglionosis (RA) and Mechanical Obstruction (MO) were the primary reasons for redo-PT, accounting for 52.50% and 36.67%, respectively. When comparing the causes of redo-PT between the literature group and our center group, RA accounted for 49.85% and 75.76%, while MO accounted for 49.85% and 21.21%, respectively. Prognostic outcomes of 31 patients from our center were analyzed, revealing no significant associations between postoperative complications and gender, age, causes of redo pull-through, or surgical approach (P > 0.05).

Conclusions: Recurrent constipation requiring redo-PT are predominantly caused by RA and MO. Gender, age, causes of redo pull-through, or surgical approach do not affect the prognosis of redo-PT. The laparoscopic approach demonstrated superior cosmetic outcomes compared to the laparotomy approach.

Keywords: Hirschsprung’s disease; Postoperative recurrence of constipation; Prognosis; Redo pull-through; Risk factors.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: This article obtained approval from the Ethics Committee with the ethics approval number TJ-IRB20230739. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Case screening flow chart of HSCR patients who underwent redo-PT for constipation recurrence in our center and references
Fig. 2
Fig. 2
Proportional analysis of reasons for redo-PT in different groups. A. Literature group; B. Our center group; C. In total. RA, Recurrent Aganglionosis; AA, Acquired Aganglionosis; MO, Mechanical Obstruction
Fig. 3
Fig. 3
Analysis of intraoperative blood loss and postoperative hospitalization duration of redo-PT between Laparoscopy Group and Laparotomy Group. A. Mann–Whitney U-test for intraoperative blood loss in redo-PT; N, number of cases in the group; RSR, rank sum ratio. B. Postoperative hospitalization duration in in redo-PT; The Boxplot and Mann–Whitney U-test was conducted by SPSS version26.0; NS, not significant
See this image and copyright information in PMC

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