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Early oral feeding versus traditional feeding after transanal endorectal pull-through procedure in Hirschsprung's
Bahar Ashjaei1, Afshar Ghamari Khameneh1,2, Gisoo Darban Hosseini Amirkhiz1
1Tehran University of Medical Sciences, Department of Pediatric Surgery, Tehran.
Insights
Early oral feeding after surgery for Hirschsprung
Area of Science:
- Pediatric surgery
- Gastroenterology
- Clinical outcomes
Background:
- Hirschsprung's disease requires surgical intervention, typically transanal endorectal pull-through.
- Postoperative feeding strategies can influence patient recovery and hospital stay.
- Optimizing feeding protocols is crucial for improving patient outcomes and reducing healthcare costs.
Purpose of the Study:
- To compare the outcomes of early oral feeding versus traditional postoperative feeding in children with Hirschsprung's disease.
- To evaluate the impact of feeding strategies on complication rates, treatment duration, and hospital stay.
- To determine the optimal postoperative feeding approach for this patient population.
Main Methods:
- An observational, comparative study involving two groups of pediatric patients undergoing transanal endorectal pull-through for Hirschsprung's disease.
- Assessment of various outcomes including infections, stenosis, abdominal distension, fever, and need for reoperation.
- Recording of intravenous fluid and antibiotic usage, with statistical analysis using Chi-square, t-tests, and Mann-Whitney tests (P < .05 significance).
Main Results:
- No significant differences in key complications like infections, stenosis, or abdominal distension between early and traditional feeding groups.
- A notable difference in the duration of antibiotic and intravenous fluid administration, with shorter durations in the early feeding group.
- Early feeding group required significantly less antibiotic and IV fluid treatment post-72 hours compared to the traditional group.
Conclusions:
- Early oral feeding demonstrates comparable outcomes to traditional feeding in pediatric patients with Hirschsprung's disease.
- Early feeding may lead to reduced antibiotic and IV fluid use, potentially shortening hospital stays and lowering costs.
- The findings suggest early postoperative feeding is a superior strategy, warranting consideration in clinical practice.
Abstract:
Our study questioned whether the outcome of postoperative early oral feeding is different from traditional postoperative feeding in children with Hirschsprung's disease who underwent transanal endorectal pull-through.This was an observational and comparative study. Patients were allocated into 2 groups. Age, gender, fever, surgery-related infectious, abdominal distension, bowel obstruction, need for reoperation, peritonitis, anastomosis leak, and abscess formation were assessed. IV fluids and antibiotics usage were recorded. A Chi-square test, independent sample unpaired Student t test and Mann-Whitney test were used. P-value < .05 was considered statistically significant.Infections occurred in no patient in group 1 and 1 patient in group 2. Stenosis occurred in 3 patients in group 1 and 2 patients in group 2. Abdominal distension occurred in 4 patients in group 1 and 3 patients in group 2. Fever occurred in 2 patients in group 1 and 1 patient in group 2 within the first 24 hours and it occurred in 13 and 17 patients, respectively, within 48 hours. All patients of group 1 (n = 15) were treated with antibiotics and intravenous fluid administration; 1 patient for 24 hours, 12 patients for 48 hours, and 1 for 72 hours, respectively. All patients of group 2 (n = 18) were treated with antibiotics and intravenous fluid administration for 5 days. We noted a significant difference regarding the duration of antibiotic treatment and intravenous fluid administration after 72 hours.This study showed that there was no difference between the outcomes of early and traditional postoperative feeding. Due to a significant difference in the antibiotics and IV fluid administration intervals between these 2 groups which cause a prolonged hospital stay and higher costs, it seems that early postoperative feeding is superior to traditional strategy.