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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.
Summary
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.
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