Optimal timing for Soave primary pull-through in short-segment Hirschsprung disease: A meta-analysis

Area of Science:

• Pediatric Surgery
• Gastroenterology
• Clinical Outcomes Research

Background:

• Short-segment Hirschsprung disease (SSHD) management involves endorectal pull-through (ERPT) surgery.
• A trend towards earlier ERPT surgery in infants with SSHD is observed.
• The impact of ERPT timing on functional outcomes remains unclear.

Purpose of the Study:

• To determine the optimal timing for endorectal pull-through (ERPT) surgery in infants with short-segment Hirschsprung disease.
• To evaluate the association between the age at ERPT and functional outcomes in SSHD patients.

Main Methods:

• A systematic literature search of PubMed for studies published between 2000 and 2019.
• Inclusion of English-language manuscripts analyzing functional outcomes after Soave ERPT for SSHD.
• Meta-analysis combining data from published studies and institutional data.

Main Results:

• A total of 780 infants were included in the meta-analysis.
• Reported functional outcomes included constipation (1.0-31.7%), soiling (1.3-26.0%), anastomotic stricture (0.0-14.6%), and anastomotic leak (0.0-3.4%).
• Infants <2.5 months at ERPT showed significantly higher rates of soiling (25.9% vs 11.4%), stricture (10.0% vs 1.7%), and leak (5.5% vs 1.3%).

Conclusions:

• Earlier Soave ERPT for SSHD may be associated with poorer functional outcomes.
• Patients undergoing ERPT before 2.5 months had increased rates of soiling, stricture, and leak.
• Further investigation into the optimal timing of ERPT for SSHD is warranted to improve patient outcomes.