Pull through for Hirschsprung disease without planned rectal decompression is safe

Area of Science:

• Pediatric Surgery
• Gastroenterology
• Developmental Biology

Background:

• Hirschsprung disease (HD) management traditionally involves delaying definitive pull-through surgery to allow for rectal washouts.
• This delayed approach aims to prepare the bowel, but its necessity and impact on outcomes are debated.

Purpose of the Study:

• To compare surgical outcomes between patients undergoing immediate pull-through surgery without planned decompression and those with deferred pull-through.
• To evaluate the safety and efficacy of early definitive surgery for Hirschsprung disease.

Main Methods:

• A consecutive series of 156 children with Hirschsprung disease undergoing pull-through surgery were retrospectively analyzed.
• Patients were classified into two groups: immediate surgery without planned decompression and delayed surgery.
• Outcomes assessed included severe complications (Clavien-Dindo grade ≥3b), need for a stoma, and revisional pull-through surgery.

Main Results:

• No significant difference in severe complications (7% vs. 8%, p=0.8) was observed between the immediate and delayed surgery groups.
• The immediate surgery group showed a trend towards fewer stomas (4% vs. 13%, p=0.059) and revisions (7% vs. 15%, p=0.1) compared to the delayed group.
• Children undergoing immediate surgery were significantly younger (mean 18 days vs. 310 days).

Conclusions:

• Performing definitive pull-through surgery for Hirschsprung disease without prior rectal decompression is safe.
• Early definitive surgery does not lead to an increased incidence of severe complications, stoma formation, or revisional surgery.
• The routine use of pre-operative stoma or rectal washouts may not be necessary for all Hirschsprung disease patients.