Reasons for failed megacolon radical operation

Abstract

Objective To report a group of failed and reoperated megacolon radical surgical cases and discuss the causes of failure.Methods A total of 187 patients underwent megacolon radical surgery during the past 3 years in a single group.Among them,42 cases (22.46％％) were operated more than twice due to failed previous surgery.The average number of previous surgery was 3.5 (3 9) times.Five patients (11.9％) had cardiac,urinary,reproductive system abnormalities or Down's syndrome.All received anorectal manometry,acetylcholinesterase (AChE) histochemical staining of rectal suction biopsy and preoperative barium enema.Those without enterostomy underwent colon transmission test for checking colon motility.Pathological diagnosis was based on the examination of specimens with hematoxylin & eosin and immunohistochemical staining.Results All of them were grouped according to pathological diagnosis.The Hirschsprung's allied disorders (HAD) group had 78 cases.And reoperation was performed due to failed previous surgery (n=22,28.21％).This group also included 46 cases of hypoganglionosis (HG) with reoperation in 8 cases (17.39％); 32 patients of intestinal neuronal dysplasia (IND) with reoperation in 14 cases (43.75％),excessive residual colonic lesion was cause of failure in this group; Hirschsprung's disease (HD) group had 109 cases and reoperation was performed due to failed previous surgery (n=20,15.6％).Residual colonic lesion led to surgery failure (n=14) and bowel twisting,retraction and anastomotic leakage (n=6).Conclusions Clinically megacolon is composed of intestinal dysganglionosis (IDs),aganglionosis (HD),intestinal neuronal dysplasia (IND),hypoganglionosis (HG) and other enteric nervous system lesions.Clinical symptoms plus pertinent examinations for making an accurate diagnosis and determining lesion distribution are quite important.Incorrect evaluations for types and range of intestinal dysganglionosis lesion result in wrong surgical approaches.And this is an important reason for surgical failure. Key words: Hirschsprung's disease; Hirschsprung's allied disorders; Intestinal neuronal dysplasia; Reoperation