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The use of postoperative calibrations in Hirschsprung disease: a practice to reconsider?
Federico Beati1, Tommaso D'Angelo1, Chiara Iacusso1
1Neonatal Surgery Unit, Bambino Gesù Children's Hospital, IRCCS, Piazza S Onofrio 4, 00165, Rome, Italy.
Insights
Discontinuing daily anal dilations after endorectal pull-through for Hirschsprung disease (HD) is safe and may reduce enterocolitis and constipation. This approach offers a feasible alternative to traditional postoperative care.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Colorectal Surgery
Background:
- Daily postoperative anal dilations are a common practice after transanal endorectal pull-through for Hirschsprung disease (HD).
- The risks and effectiveness of this traditional approach require further evaluation.
Purpose of the Study:
- To analyze the potential risks and effectiveness of a new protocol omitting daily postoperative anal dilations.
- To compare outcomes between a non-dilation protocol and traditional dilation post-HD surgery.
Main Methods:
- A prospective study compared infants (<6 months) undergoing transanal endorectal pull-through.
- Group A (non-dilation) was compared 1:2 to Group B (daily dilations), matched for age and colonic segment.
- Exclusion criteria included associated syndromes, extended aganglionosis, and enterostomy.
Main Results:
- No significant differences in anastomotic complications (stenosis, leakage) were observed between groups.
- Group A showed a significantly lower incidence of enterocolitis (p=0.03) and constipation (p=0.02).
Conclusions:
- A non-dilation strategy after endorectal pull-through for HD is a feasible alternative.
- This approach does not increase anastomotic complication risks and may reduce enterocolitis and constipation.
Purpose:
Daily postoperative anal dilations after endorectal pull-through for Hirschsprung disease (HD) are still considered a common practice. We analyzed the potential risks of this procedure and its effectiveness compared to a new internal protocol.
Methods:
All infants (< 6 months of age) who underwent transanal endorectal pull-through between January 2021 and January 2023 were prospectively enrolled in a new postoperative protocol group without daily anal dilations (Group A) and compared (1:2 fashion) to those previously treated by postoperative anal dilations (Group B). Patients were matched for age and affected colonic tract. Patients with associated syndromes, extended total intestinal aganglionosis, and presence of enterostomy were excluded. Outcomes considered were: anastomotic complications (stenosis, disruption/leakage), incidence of enterocolitis, and constipation.
Results:
Eleven patients were included in group A and compared to 22 matched patients (group B). There were no significant differences in the occurrence of anastomotic complications between the two groups. We found a lower incidence of enterocolitis and constipation among group A (p = 0.03 and p = 0.02, respectively).
Conclusion:
A non-dilation strategy after endorectal pull-through could be a feasible alternative and does not significantly increase the risk of postoperative anastomotic complications. Moreover, some preliminary advantages such as lower enterocolitis rate and constipation should be further investigated.
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