Optimal time for single-stage pull-through colectomy in infants with short-segment Hirschsprung disease

Area of Science:

• Pediatric Surgery
• Gastroenterology
• Medical Diagnostics

Background:

• Short-segment Hirschsprung disease (HSCR) is the most common form, affecting about 75% of patients.
• The optimal timing for single-stage endorectal pull-through (ERPT) surgery in neonatal HSCR patients remains debated.

Purpose of the Study:

• To investigate the optimal age for single-stage ERPT surgery in infants with short-segment HSCR.
• To compare diagnostic accuracy and postoperative outcomes based on operative age.

Main Methods:

• Retrospective cohort study of 198 infants with short-segment HSCR.
• Patients stratified into two groups: operative age ≤3 months (Group A) and >3 months (Group B).
• Preoperative diagnoses confirmed by contrast enema and rectal biopsy; outcomes assessed postoperatively.

Main Results:

• Diagnostic accuracy was lower in Group A (67.2% contrast enema, 93.5% biopsy) compared to Group B (81.4% contrast enema, 94.9% biopsy).
• Group A had higher rates of short-term anastomotic leakage and midterm soiling compared to Group B.
• Constipation recurrence was nil in Group A and 1.9% in Group B.

Conclusions:

• Infants undergoing single-stage ERPT surgery at ≤3 months old had less accurate diagnoses and poorer outcomes.
• Delaying ERPT surgery until infants are older may be more beneficial for short-segment HSCR.