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Diagnosis of Hirschsprung's Disease by Immunostaining Rectal Suction Biopsies for Calretinin, S100 Protein and Protein Gene Product 9.5

Diagnosis of Hirschsprung's Disease by Immunostaining Rectal Suction Biopsies for Calretinin, S100 Protein and Protein Gene Product 9.5

Published on: April 26, 2019

Pull through for Hirschsprung disease without planned rectal decompression is safe.

Chloe Roy¹, Bruce Jaffray¹

¹Department of Paediatric Surgery, The Great North Children's Hospital, Newcastle upon Tyne, UK.

Journal of Pediatric Surgery

|November 19, 2022

Summary

This summary is machine-generated.

Early definitive surgery for Hirschsprung disease (HD) is safe, avoiding planned rectal decompression or washouts. This approach does not increase complications, stoma rates, or revisions, challenging traditional treatment timelines.

Keywords:

Complications Hirschsprung disease Surgical outcomes

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Published on: November 8, 2024

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.