Pullthrough pitfalls in treating Hirschsprung disease
Bibliographic record
Abstract
Complications after a pullthrough for Hirschsprung disease can occur either early or late in the postoperative period. A small number of these patients may require reoperation, with rates varying from 3% to 28% at a large volume colorectal center. 1 2 Indications for reoperation include stricture, leak, fistula, transition zone pullthrough or retained aganglionosis, retained Soave cuff, or a Duhamel spur. Some of these may manifest as obstructive symptoms or constipation, which can be seen in 11% to 42% of patients.3 Other patients may develop soiling and fecal incontinence, which can be caused by sphincter injury during surgery or by loss of the dentate line.4 In a review of 46 redo pullthroughs, 71% occurred because of aganglionosis or a transition zone pullthrough, 19% from stricture or obstruction by the Duhamel pouch, and 8% from a tight Soave cuff.2 The choice of pullthrough, whether a Swenson, Yancey-Soave, or Duhamel, does not influence the rate of complication but rather each has its own unique pitfalls to avoid.5 The timing of surgery, whether performed as a neonate or delayed into infancy, continues to be debated, with a large study from the Pediatric Colorectal and Pelvic Learning Consortium (PCPLC) showing no difference in anastomotic or cuff stricture, Duhamel spur, or transition zone pullthrough, and several others showing higher rates of stricture and leak when repairs are done in the neonatal period.6 7 In this review, we discuss avoidable pitfalls during the pullthrough procedure and provide guidance for identification and prevention.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.004 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.002 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.003 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".