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Are routine dilatations necessary post pull-through surgery for Hirschsprung disease?
Olugbenga Aworanti1, Judy Hung, Dermot McDowell
1Department of Paediatric Surgery, Children's University Hospital, Dublin, Ireland.
Insights
Routine anal dilatations after Hirschsprung disease surgery did not reduce stricture or enterocolitis rates. Late-onset strictures were observed in the routine dilatation group, suggesting a different cause.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Clinical Outcomes Research
Background:
- Hirschsprung disease (HD) management involves pull-through surgery.
- Anastomotic strictures and enterocolitis are potential complications post-surgery.
- The role of routine anal dilatations (AD) in preventing these complications is unclear.
Purpose of the Study:
- To compare anastomotic stricture and enterocolitis rates in HD patients with and without routine anal dilatations (AD) post-pull-through surgery.
- To evaluate the benefit of routine anal dilatations in managing Hirschsprung disease outcomes.
Main Methods:
- Retrospective review of 73 children operated on for HD between 1997 and 2010.
- Exclusion of patients with Down syndrome or total colonic aganglionosis.
- Comparison of stricture and enterocolitis rates between a routine AD group and a no-AD group (dilatations initiated upon stricture diagnosis).
Main Results:
- No significant difference in anastomotic stricture rates (13% AD vs. 14% NAD; p=1.000).
- No significant difference in enterocolitis rates (23% AD vs. 28% NAD; p=0.788).
- Longer follow-up in the NAD group, but duration did not correlate with complication rates.
Conclusions:
- Routine anal dilatations do not appear to reduce the risk of anastomotic strictures or enterocolitis after HD surgery.
- Late-onset strictures were noted in the routine AD group, potentially indicating a different etiology.
Introduction:
We aim to compare the anastomotic stricture and enterocolitis rates between groups who either had or did not have anal dilatations (AD or NAD) prescribed routinely post pull-through surgery for Hirschsprung disease (HD); by this means, we will evaluate the benefit of routine dilatations.
Methods:
A retrospective review of the records of all children operated on for HD between 1997 and 2010 was performed. Associated Down syndrome and total colonic aganglionosis were excluded. Two cohorts were identified; those who had anal dilatation prescribed routinely (AD) and those who did not (NAD). In the latter group, if an anastomotic stricture was subsequently diagnosed, anal dilatations were initiated. The anastomotic stricture and enterocolitis rates between groups were compared. Significance was set at p < 0.05.
Results:
There were 73 children that met the inclusion criteria (30 AD and 43 NAD). The NAD group had the longer mean follow-up period of 91 versus 59 months (p = 0.026); however, follow-up duration was unrelated to the anastomotic stricture rates (p = 0.575) and enterocolitis rates (p = 0.150). The anastomotic stricture rates were 13% (n = 4) versus 14% (n = 6) (p = 1.000) for the AD and NAD groups, respectively (relative risk [95% confidence interval] RR [95% CI], 0.95 [0.29 to 3.09]; p = 0.94). The mean duration between surgery and stricture occurrence was 348 versus 74 days for the AD and NAD groups, respectively. The enterocolitis rates were 23% (n = 7) versus 28% (n = 12) (p = 0.788) for the AD and NAD groups, respectively (RR [95% CI], 0.84 [0.37 to 1.87]; p = 0.66).
Conclusion:
We have not shown a reduced risk of developing anastomotic strictures or enterocolitis if anal dilatations are prescribed routinely. However, when routine dilatations were prescribed, predominantly late onset strictures of perhaps a different etiology occurred.
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