Combined Radial Incision and Steroid Injection for Refractory Colorectal Stenosis After Pull-Through Surgery in Hirschsprung Disease: An Innovative Conservative Treatment.

Abstract

Anastomotic stenosis after pull-through surgery remains a challenge in the management of Hirschsprung disease. Based on the management of esophageal stenosis, we evaluated the efficacy of combined radial incision and steroid injection for the treatment of refractory colorectal anastomotic stenosis after pull-through. Combined radial incision and steroid injection is an alternative conservative treatment of refractory anastomotic stenosis after pull-through for Hirschsprung disease, avoiding a potential complicated redo pull-through surgery. We included patients with rectosigmoid Hirschsprung disease who developed a refractory anastomotic stenosis after a laparoscopic-assisted Swenson pull-through at Robert-Debré Children University Hospital in Paris, France. Refractory stenosis was defined as obstructive symptoms associated with an anastomotic stenosis on rectal examination without improvement after serial anal dilations. Under general anesthesia, an injection of 10-mg delayed-action steroid per quadrant was combined with a radial incision of the stenosis using monopolar cautery. Combined radial incision and steroid injection were performed in 4 children for either early or late refractory stenosis. This resulted in improved refractory anastomotic stenosis, avoiding a redo pull-through in 75% of patients. One child presented with transient improvement after a combined radial incision and steroid injection but developed recurrent stenosis despite additional combined radial incision and steroid injection and redo pull-through. The median follow-up was 29 months. We observed a clinical improvement in all the patients after combined radial incision and steroid injection. Steroid injection should be considered as a potential alternative therapy for anastomotic stenosis.