Timing of the definitive procedure and ileostomy closure for total colonic aganglionosis HD: Systematic review

Area of Science:

• Pediatric Surgery
• Gastroenterology
• Clinical Research

Background:

• Total Colonic Aganglionosis-Hirschsprung Disease (TCA-HD) requires surgical intervention, typically involving pull-through and ileostomy closure.
• The optimal timing for these procedures, particularly regarding potential complications like diaper rash, remains a subject of clinical debate.

Purpose of the Study:

• To evaluate the evidence supporting current recommendations for the timing of pull-through and ileostomy closure in TCA-HD.
• To determine if delaying these surgical steps influences the incidence of postoperative diaper rash.

Main Methods:

• A systematic review and meta-analysis of studies reporting on TCA-HD cases was conducted.
• Databases searched included Medline, PubMed, Cochrane, and ClinicalKey without date restrictions.
• Data on patient numbers, ages at surgery and ileostomy closure, complications, and procedure types were analyzed. Diaper rash rates were statistically assessed.

Main Results:

• Twenty-five studies encompassing 218 patients with TCA-HD were reviewed.
• No statistically significant correlation was found between the age at definitive surgery or ileostomy closure and the development of diaper rash.
• The reviewed studies generally met high methodological quality standards (6-9/9 stars on NOS).

Conclusions:

• The findings suggest that delaying definitive surgery or ileostomy closure for TCA-HD is not supported by current literature.
• Postoperative diaper rash is not frequently reported in TCA-HD cases, thus not warranting prolonged ileostomy duration.
• Evidence does not support maintaining a diverting ileostomy until toilet training solely to prevent perianal excoriation.