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Is daily dilatation by parents necessary after surgery for Hirschsprung disease and anorectal malformations?

Sara J Temple1, Anna Shawyer, Jacob C Langer

  • 1Division of General and Thoracic Surgery, Hospital for Sick Children, Toronto, Ontario, Canada.

Journal of Pediatric Surgery
|January 17, 2012
PubMed

Insights

Weekly calibration by surgeons offers similar outcomes to daily parental dilatation after surgery for Hirschsprung disease and anorectal malformations. This approach is gentler for children and parents, making it a viable alternative.

Area of Science:

  • Pediatric Surgery
  • Gastroenterology
  • Colorectal Surgery

Background:

  • Postoperative management of Hirschsprung disease (HSCR) and anorectal malformations (ARMs) often involves daily anal dilatation.
  • The efficacy and risks associated with this intensive dilatation regimen require critical evaluation.

Purpose of the Study:

  • To compare the outcomes of routine daily parental dilatation versus weekly surgeon-led calibration in children post-HSCR or ARM repair.
  • To assess the incidence of complications such as stricture, anastomotic disruption, and enterocolitis between the two management strategies.

Main Methods:

  • Retrospective chart review of pediatric patients who underwent HSCR or ARM repair over a 5-year period.
  • Exclusion criteria included long-segment HSCR and anal stenosis.
  • Patients were divided into two groups: daily parental dilatation and weekly surgeon calibration with as-needed parental dilatation.

Main Results:

  • A total of 95 patients were analyzed (34 HSCR, 61 ARM).
  • Weekly calibration resulted in only 5 (17%) patients requiring conversion to daily dilatation due to late narrowing.
  • No significant differences were observed in stricture development, anastomotic disruption, perineal excoriation, or enterocolitis between the groups.

Conclusions:

  • Weekly surgeon calibration demonstrates comparable outcomes to daily parental dilatation for HSCR and ARM postoperative care.
  • The weekly calibration approach is less burdensome for families and patients.
  • This method warrants consideration as a preferred postoperative management strategy.
Abstract

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