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Clinical relevance of inflammation on rectal biopsy for Hirschsprung disease: An outcomes analysis
Dimitra M Lotakis1, Nathan S Rubalcava1,2, Natalie M Lopyan1
1Division of Pediatric Surgery, Department of Surgery, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, Michigan, USA.
Insights
Inflammation on Hirschsprung disease (HSCR) rectal biopsies is linked to higher anastomotic leak rates. Managing this inflammation before surgery may improve outcomes for affected children.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Pathology
Background:
- Inflammation on diagnostic rectal biopsy for Hirschsprung disease (HSCR) is frequently reported but its clinical significance remains unclear.
- Understanding the impact of inflammation on HSCR patient outcomes is crucial for optimizing surgical management.
Purpose of the Study:
- To investigate the association between inflammation on diagnostic rectal biopsy and complication rates in children with HSCR.
- To compare the management and outcomes of HSCR patients with and without inflammation on biopsy.
Main Methods:
- Retrospective review of 49 children with HSCR who underwent endorectal pull-through (ERPT) between 2010 and 2020.
- Primary outcome: overall complications within 30 days of ERPT. Secondary outcomes: operative intervention timing/type, postoperative enterocolitis.
Main Results:
- Seventeen of 49 children had inflammation on biopsy; they were more likely to present with enterocolitis and undergo a prior colostomy.
- Children with inflammation showed a significantly higher anastomotic leak rate (p=0.04).
- No significant difference in outcomes was observed between primary ERPT and staged pull-through in the inflammation subgroup.
Conclusions:
- Inflammation on diagnostic rectal biopsy for HSCR is associated with an increased risk of anastomotic leaks.
- Further prospective studies are needed, but strategies to mitigate inflammation before definitive surgery may improve outcomes.
Objectives:
Inflammation on diagnostic rectal biopsy for children with suspected Hirschsprung disease (HSCR) is reported on pathology, and its significance is unknown. We describe the management and outcomes of a cohort with inflammation on rectal biopsy compared to those without. Specifically, to address the hypothesis that inflammation on diagnostic biopsy is associated with increased complication rates irrespective of intervention type and timing.
Methods:
A single institution retrospective review of children with HSCR who underwent biopsy and endorectal pull-through (ERPT) from 2010 to 2020 was performed. The primary outcome was overall complications at 30-days following ERPT. Secondary outcomes included timing and type of operative intervention as well as postoperative enterocolitis diagnosed within 6-months of ERPT.
Results:
Forty-nine children were identified; inflammation was present on diagnostic biopsy for 17 children. Those with inflammation were more likely to have clinical evidence of enterocolitis at the time of biopsy (p = 0.001) and were more likely to undergo leveling colostomy before ERPT (p = 0.01). Children with inflammation had a higher anastomotic leak rate (p = 0.04). Subgroup analysis of patients with inflammation undergoing primary ERPT versus leveling colostomy demonstrated no significant difference in outcomes following definitive ERPT.
Conclusions:
Our study suggests inflammation on diagnostic rectal biopsy for HSCR is associated with increased anastomotic leak rates. While additional prospective studies are indicated, attention to methods of mitigating inflammation and confirming its resolution before definitive pull-through may be of benefit for improving clinical outcomes in patients found with inflammation on diagnostic rectal biopsy.
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