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Continuous transanal decompression for infants with long- and total-type Hirschsprung's diseases as a bridge to
Kyoko Mochizuki1, Masato Shinkai2, Norihiko Kitagawa2
1Department of Surgery, Kanagawa Children's Medical Center, 2-138-4 Mutsukawa, Minami-ku, Yokohama, 232-0066, Japan. kmochizuki@kcmc.jp.
Insights
Continuous bowel decompression with an indwelling transanal tube (ITT) is a safe and effective preoperative method for infants with long-segment or total Hirschsprung
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Medical Devices
Background:
- Hirschsprung's disease (HD) involves congenital absence of ganglion cells in the distal bowel.
- Long-segment (L)- and total (T)-type HD present significant surgical challenges.
- Preoperative management is crucial for optimizing infant health before definitive surgery.
Purpose of the Study:
- To evaluate the efficacy of continuous bowel decompression using an indwelling transanal tube (ITT).
- To assess the utility of ITT for preoperative management in infants with L- or T-type HD.
- To determine if ITT facilitates single-stage curative surgery, avoiding ostomy.
Main Methods:
- Retrospective review of seven infants with L- or T-type HD undergoing preoperative bowel decompression.
- Placement of a 10-12F flexible dual lumen ITT under fluoroscopic guidance.
- Continuous decompression via open drainage and regular suction for a median of 65 days.
Main Results:
- No instances of abdominal distention or enterocolitis were observed during ITT management.
- Six of seven patients remained at home until curative surgery.
- Weight-for-age Z-scores were maintained or improved in five patients; ITT replacement averaged three times per patient.
Conclusions:
- Continuous bowel decompression with an ITT is a safe, easy, and effective preoperative strategy for L- or T-type HD.
- This method may enable single-stage curative surgery, potentially eliminating the need for colostomy or enterostomy.
Background:
The purpose of this study is to assess the usefulness of continuous bowel decompression using an indwelling transanal tube (ITT) for preoperative management in infants with long-segment (L)- or total (T)-type Hirschsprung's disease (HD).
Case Presentation:
Between 2012 and 2015, seven patients with L- or T-type HD underwent preoperative bowel management by continuous bowel decompression using an ITT during waiting period for curative surgery. Continuous bowel decompression was done using an ITT, a 10-12F flexible dual lumen tube placed through the rectum up to the dilated colon under fluoroscopic guidance and secured to the bilateral buttocks. The ITT tips were located at least in a dilated colon or the cecum if there was no radiographic transitional zone. The ITT was left open for continuous drainage, and its patency was checked by regular suction until the curative operation. The patient status and complications of this preoperative management were reviewed retrospectively.
Results:
The median duration of decompression management was 65 (17-137) days. During decompression period, neither abdominal distention, enterocolitis, nor other complications occurred and six patients could stay at home until the curative operation. The weight-for-age Z-score at curative surgery was the same as or higher than that at birth in five patients. ITT replacement was needed three times per patient on an average for accidental ITT removal, ITT stenosis, or ITT hardening.
Conclusions:
Bowel management by continuous bowel decompression using an ITT is easy, safe, and effective for preoperative management in patients with L- or T-type HD and may permit single-stage surgery rendering colostomy or enterostomy unnecessary.
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